Donald CorenmanKeymasterApril 30, 2011 at 11:31 pmPost count: 52
Hi Dr Corenman,
I am a junior doctor, currently doing orthopaedics posting.
I found your website very useful and informative, thank you.
I wonder if you also have some good concise informations or videos regarding cervical skull traction applications and their aftercare?
It is very rarely done here and I need to do present it for educational purpose.
Thank you!Donald Corenman, MD, DCModeratorApril 30, 2011 at 11:35 pmPost count: 8468
Here is the answer.
Skull traction can be managed by a Halo (4 pin fixation), Gardner-Wells or Mayfield traction (2-3 pin fixation but only temporary for intraoperative traction). The only rigid fixation for longer term use is the Halo attached to a 4 bar torso vest. For intraoperative surgical use, the Gardner-Wells device is good for axial traction but will not control rotation as it is 2 point fixation. The Mayfield will allow axial traction and control rotation too as it is 3 point fixation. Inserting the pin requires penetrating only the outer cortex of the skull. The inner cortex should remain intact. This requires a torque driver and about 8 inch-pounds of pressure. The posterior skull is thicker and can withstand a greater torque than the anterior and lateral skull.
If the pins are for long term use (Halo with vest), pin cleaning needs to be performed daily to twice daily. This is done with a dilute solution of Betadine, saline, soap and water, dilute hydrogen peroxide or some use an alcohol solution. The alcohol is desiccating, the hydrogen peroxide is effective but both can leave larger scars. Make sure the pin sites do not crust over (eschar) as this leads to infection. The pin sites will be colonized by bacteria and the cleaning keeps this under control. Q-tips can be used to clean the pin sites but use a new Q-tip on each site as to not spread any bacteria from one pin to another. If a frank infection occurs and the pins are still solidly planted, oral antibiotics can be used. If the pin site loosens in the face of an infection, the pin will need to be moved. If the pin loosens but there is no infection, the pin can be carefully tightened with a torque driver but be very careful not to penetrate the interior cortex of the skull.
Remember that Halo vest use will immobilize the spine but not fully. A very unstable spine can still cause neurological compromise with Halo vest stabilization.
Hope this helps.
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