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 primar ily 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, wh o designed skull tongs for cervical spine traction at the University of Alb erta several years before Crutchfield's first case. Hepburn was the first n eurosurgeon at the University of Alberta in Edmonton. On the basis of his e xperience treating wounded soldiers in World War I, he developed the hypoth esis that traction would promote healing in cervical spine injuries. Hepbur n 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 ap plied 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 t o 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 Britis h Medical Society in 1930, and he is thought to have discussed his tongs du ring the conference. Hepburn's work has received some attention previously; his original tongs were included in a 1973 Smithsonian Institute exhibit o n cervical spine traction as an example of an early cranial traction device . However, his contributions are underappreciated in the neurosurgical comm unity and deserve wider recognition.