Spine Traction Research Articles

Howard H. Hepburn and the Development of Skull Tongs for Cervical Spine Traction

The first use of skull tongs for cervical spine traction is credited primarily to W.G. Crutchfield. In 1933, Crutchfield described his application of extension tongs to the calvaria of a 23-year-old woman with a traumatic C2-C3 fracture. Less recognized are the contributions of Howard H. Hepburn, who designed skull tongs for cervical spine traction at the University of Alberta several years before Crutchfield's first case. Hepburn was the first neurosurgeon at the University of Alberta in Edmonton. On the basis of his experience treating wounded soldiers in World War I, he developed the hypothesis that traction would promote healing in cervical spine injuries. Hepburn designed skull extension tongs that were modeled on common ice tongs, and he used an automobile inner tube as an elastic to keep the tongs firmly applied to the patient's head. These tongs were first used in the mid-1920s, and by 1930 they were applied routinely. Crutchfield's 1933 report refers to the application of "Edmonton extension tongs." This suggests that he was at least indirectly aware of Hepburn's work, although how this information reached him is not entirely clear. Hepburn attended a meeting of the British Medical Society in 1930, and he is thought to have discussed his tongs during the conference. Hepburn's work has received some attention previously; his original tongs were included in a 1973 Smithsonian Institute exhibit on cervical spine traction as an example of an early cranial traction device. However, his contributions are underappreciated in the neurosurgical community and deserve wider recognition.

A Biomechanical Comparison of Gardner-Wells Tongs and Halo Device Used for Cervical Spine Traction

Unstable cervical spine fractures and dislocations are often reduced by the application of axial traction using a halo or Gardner-Wells tongs. Failure of tong or halo attachment can cause substantial morbidity and usually occurs at the pin-bone interface. Institutions commonly clean and reuse tongs. The effect of tong wear on pullout strength and the strength of the halo used as a traction device have not been documented. A skull model biomechanically similar to human calvarium was used to compare the axial pullout strengths of four sets of new tongs, three sets of rarely used tongs, and one set of heavily used tongs, as well as a standard four-pin halo. The pullout strength of tongs tightened to the manufacturer's recommended level appeared to decrease with increased use. Measurement of the pin force generated by each set of tongs and of the spring constant of each spring, as well as inspection of the tongs after testing, suggested that the decrease in pull-out strength may be partly attributable to spring and/or pin wear. The pullout strength of the halo or of the new or slightly used tongs but not the heavily used tongs exceeded the maximum weight used clinically in cervical spine traction. The data suggest that consideration be given to replacement or recalibration of heavily used tongs.