Emergent closed reduction of cervical facet dislocations: effect of a standardised protocol and purpose-built table on time to reduction

Abstract

Background: This study investigates the time to closed reduction of cervical facet joint dislocations using a standardised protocol and purpose-built reduction table compared to a historical control group.

Methods: This prospective cohort study was conducted at a tertiary referral hospital in South Africa and involved adults with cervical dislocations who underwent closed reduction. The intervention group included patients who were managed with a standardised protocol and purpose-built table, and the control group included patients managed with the traditional reduction method. Relevant data was extracted from medical records, and time to reduction, among other variables, was compared between groups.

Results: The study included 30 and 51 patients in the intervention and control groups, respectively. The time from contact with the orthopaedic consultant to the initiation of reduction was significantly shorter in the intervention group versus the control group, with a median of 1 h versus 9 h 15 min (p < 0.001). There was no association between use of the table and reduction success. However, there was a significant difference in neurological improvement: eight (40%) patients and five (12%) patients in the intervention and control groups, respectively (p = 0.02).

Conclusion: This study showed that an intervention within an orthopaedic department could decrease delay for closed cervical facet reduction in a resource-limited setting, despite wider systemic challenges. For this injury, any meaningful timesaving is invaluable due to the implications for neurological recovery, rehabilitation needs and long-term prognosis.

Level of evidence: 3