J Korean Orthop Assoc.  2013 Aug;48(4):258-265.

Closed Traction Reduction as an Initial Management for Subaxial Unilateral Facet Dislocation

• Song KJ
• Lee SK
• Lim JH
• Ko JH
• Lee KB

Abstract

PURPOSE
Subaxial unilateral facet dislocation requires immediate reduction; however, cases of failure with reduction have also been reported. We analyzed the factors preventing closed traction reduction and attempted to determine the efficacy and indications of closed traction reduction.
MATERIALS AND METHODS
We selected 26 patients, 17 men and nine women. The average age of the patients in selected group was 49 years (20-69 years). Each patient was first treated with Gardner head traction and closed traction reduction. Each patient was checked for the degree of locking of the dislocated segment, intervertebral disc herniation, the degree of contralateral facet joint subluxation, and accompanied fracture. The effect of the location of the injured segment, age, and sex on closed reduction traction was analyzed.
RESULTS
A high rate of unsuccessful closed traction reduction was observed for patients with more than 50% locking of the dislocated facet joint (p=0.039). Intervertebral disc herniation, the degree of contralateral facet joint subluxation, facet joint fracture, and pedicle and lamina fracture were unrelated to the success of closed traction reduction. The location of dislocation and sex showed no statistically significant relevance to failure of closed traction reduction. A high rate of failure was observed for patients younger than 40 years. Of the 26 patients, closed traction reduction was successful for 12 and unsuccessful for 14.
CONCLUSION
For patients whose degree of locking of the dislocated facet joint is less than 50%, closed traction reduction using skull traction is considered effective, however, for patients younger than 40 years or with more than 50% locking of the dislocated facet, prompt reduction under general anesthesia and subsequent appropriate surgery is considered beneficial.

Keyword

subaixal unilateral facet dislocation; locking of facet joint; closed traction reduction

MeSH Terms

Anesthesia, General
Dislocations
Female
Head
Humans
Intervertebral Disc
Male
Skull
Traction
Zygapophyseal Joint

Figure

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  Figure 1 (A) This radiograph shows a unilateral facet dislocation in a 30-year-old male at C3-4 level, (B) shows that closed reduction failed by Gardner-Well tongs traction. (C) T2 sagittal magnetic resonance imaging; (D) Left side sagittal computed tomography (CT) image; (E) Right side sagittal CT image. (F) This radiograph shows spontaneous reduction of a dislocated facet at C3-4 level without manipulation after anesthesia.

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  Figure 2 (A) Lateral view radiograph of a 31-year-old male. Listhesis of C6 on C7 with dislocation of the left unilateral facet joint. Unilateral complete interlocking of the articular facets is shown. (B) Lateral view radiograph of a 61-year-old male. Listhesis of C5 on C6 with dislocation of the right unilateral facet joint.

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  Figure 3 (A) Left C6-7 facet complete interlocking of articular facets is shown in the computed tomography (CT) image. (B) Right C5-6 facet complete interlocking of articular facets is shown in the CT image.

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