Shahzad Ahmad, Latif Khan, Shafqat Waseem, Ashfaq Ahmed, Saeed Ahmad, Haseeb Hussain, Shehzad Javed, Rizwan Akram, Amer Aziz.
Functional outcome in patients with bilateral post traumatic facet jump dislocation after close reduction and skull traction.
Pak J Surg Jan ;35(1):49-54.

Objective: The objective of this study was to assess the outcome of skull traction in patients of acute post-traumatic bilateral facet dislocation. Study Design: Descriptive case series Setting: Department of Orthopedics and Spine Surgery, Ghurki Trust teaching hospital Lahore Duration of Study: December 15, 2015 till June 14, 2016 Sample Size: Sample size of 100 patients is calculated with 95% confidence level, 10% of margins of error and expected percentage of neurological improvement i.e. category E according to ASIA classification i.e 46.7 %( 7) aft er skull traction in closed reduction of acute post traumatic bilateral facet dislocation. Material and Methods: Aft er taking approval from hospital ethical committee, 100 patients fulfilling selection criteria were included in this study. Pre-op ASIA scale was applied and neurological grade were noted. Position of patient was in supine with reverse trendelenburg in emergency operating room. Patients were awake and conscious and skull traction was applied with garden well skull tongs about 01cm above both pinna in line with external auditory meatus below the equator of skull without risk of superficial temporal vessels injury in local anesthesia. After tightening of pins initial weight of 10lbs for skull and 05lbs for each vertebrae level were added. Aft er 12 hrs of series of interval 05lbs weight were added and clinical neurological examination done neurology graded according to ASIA scale. Neurological improvement was labeled as per operational definitions. Data analysis was done by using computer soft ware SPSS version 17. Results: The mean age of patients in this study was 36.88±9.73 years and there were 69% males and 31% females. The neurological improvement was seen in 84.00% patients whilst in 16.00% patients, there was no neurological improvement. The reduction was achieved in 77.00% patients and could not be achieved in 23.00% patients. Conclusion: Skull traction is an effective treatment method of closed reduction in bilateral facet dislocations. It improves the ASIA score significantly, improves neurological function and has successful reduction in majority of patients. The neurological improvement has significant association with non-obese and ASIA score however, reduction is only significantly associated with obesity.

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