16 - Spine fractures
Published online by Cambridge University Press: 05 February 2014
Summary
Indications
Halo devices are used in a variety of trauma settings, including:
Reduction of cervical spine facet subluxations and dislocations (usually via axial traction applied through the halo).
Stabilization of non-displaced cervical spine fractures.
Post-reduction stabilization of cervical spine fractures, subluxations and dislocations.
Temporary stabilization of a cervical spine injury, prior to definitive surgical treatment, or to facilitate safe transfer of the patient to a specialist spinal centre.
If the patient is physically able to mobilize, the halo can be attached to a ‘vest’. The vest may be a custom-made plaster or fibreglass orthosis, or one of the readily available ‘off-the-shelf’ devices. Several orthopaedic implant manufacturers market combinations of haloes and vest orthoses, in a range of sizes. The most useful halo and vest devices contain no ferrous components and are therefore MRI-compatible, permitting scanning of the patient after application.
Preoperative planning
Most halo and halo–vest systems are available as pre-packed kits containing all of the necessary implants and tools for halo application and subsequent attachment of the halo to a detachable vest. A careful check of the manufacturer’s kit inventory against the kit components and instruments should be done in every case; do not assume that even a pre-packed kit will be complete! If the halo is to be used for ambulatory cervical spine stabilization a suitably sized orthosis (vest) is selected. Standard antiseptic skin preparation solutions should be available. If not supplied in the halo kit, a small pointed scalpel will also be needed.
Measure head circumference using a tape measure and select the smallest possible halo size (Fig. 16.1.1).
The halo selected should permit an air gap of approximately 10 mm between the inner aspect of the halo and the largest circumference of the skull, measured as shown in Fig. 16.1.2.
- Type
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- Information
- Practical Procedures in Orthopaedic Trauma Surgery , pp. 426 - 450Publisher: Cambridge University PressPrint publication year: 2014