Halo Orthosis

Question 1

What type of injuries is a halo orthosis utilized?

Answer 1

upper cervical

Question 2

What injuries is halo immobilization the definitive treatment?

Answer 2

Adults:
occipital condyle fx
occipitocervical dislocation
stable Type II atlas fx (stable Jefferson fx)
type II odontoid fractures in young patients
type II and IIA hangman’s fractures

Pediatrics:
atlanto-occipital dissociation
Jefferson fractures (burst fracture of C1)
atlas fractures
unstable odontoid fractures
persistent atlanto-axial rotatory subluxation 
C1-C2 dissociations
subaxial cervical spine trauma

Question 3

What age group is halo immobilization contraindicated?

Answer 3

Elderly; 21% mortality rate in those >79

Question 4

What is the safe zone for pin placement in a halo orthosis?

Answer 4

1cm region in lateral 1/3 of the orbit at the skull equator (just above the eyebrow)
lies lateral to supraorbital n.

Question 5

What is the appropriate torque for halo pins?

Answer 5

8lbs for adults

2-4lbs for peds (finger-tight); more pins less torque

Question 6

What are the most common complications of halo pins and how are they treated?

Answer 6

Loosening (36%); exchange pin

Infection (20%); remove pin and abx

Question 7

What is the most common cranial nerve palsy after halo orthosis?

Answer 7

CN VI (abducens n.)