Responses to infant halo question

Responses to infant halo question

Baby is 4 1/2 months, Downs syndrome. Spinal cord injured due to congenital
instability and multiple intubations.

Got a custom ring and vest from PMT. Shipped here in 2 days in spite of the
fact that there were no planes flying. (UPS really came through somehow!)
Surgeon applied halo and performed surgery.

His office tells me that the halo went fine but the baby is non-responsive
below the lesion level. Still hoping for improvement.

Original question and responses follow:

Hello all.

Received a call this afternoon. Pediatric neurosurgeon would like to put a
halo on a 5 month old.

Any thoughts or suggestions would be very welcome.

Ed Lydon, CO
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 Call PMT at 1-800-MANKIND. I think they have, orcan assemble from
measurements, pediatric systems that will meet your needs. Soundslike a
challenging case. Be sure to ask them for any specificrecommendations on
application.
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yeah..contact PMT...@ 1800-mankind and tell them what you got...probably need
ax-small halo with a size 1 peds vest...but you might need to go custom with
thevest.. good luck..

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I have used acustom made - from a cast - "Minerva" CTLSO. we cast
the babyand his entire head, in order to make a plastic type hood to control
M-L andthen used a forehead strap and removable chin piece,( with plastic and
strapoptions - for feeding), to control A-P. The thoracic section
wasBi-valved A-P and removable for chnging, cleaning, etc. The only
concernwe had, was pressure and friction on the back of the head - this
waspartially due to the pts large amount of thick curly course hair.
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PMT willcustom make a head ring in 24 hrs. and you need to make a tlso to
attach it. wehave done many.
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The primaryconcern in a child this young is their developing fontanels and
suturesthroughout the cranium. As a halo pin is torqued, the purchase
you'rehoping to gain at the pin/bone interface can be compromised by the
shiftingplate of bone (due to the immature fontanels and sutures). If you
canconsider a non-invasive CTO, that would be preferable.
Johnson'sOrthopedic Designs offers a nicely design pediatric CTO that we've
used for afew cases. If you do use a halo, you'll want to use no less than 8
pins,torqued to just 2 pounds. Having a pin torqued that low can be tricky,
aswe've found halo wrenches to often be accurate in the plus or minus range
of asmuch as a pound. For this reason, we're using a wrench that records
thetorque in "inch/ounces" rather than pounds for greater accuracy.

I hope you find this helpful, and best of luck for this challenging case!
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Don't doit! If the sutures of the skull are not sufficiently fused, the bones
will rideover each other, causing the skull to become smaller in diameter and
fall outfrom between the pins. This is not just a theoretical possibility, I
have seenit happen with a six month old (10 pins at 1 in/lb. torque each). I
don't knowwhat the source is, but the rule of thumb that I have heard is that
the childneeds to be at least 10 months old to go into a halo.

PMT makes vests that will fit children this small (try the Pedi 00), but
theskull is just too soft at this age.
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I amcurrently taking the Orthotics course at Northwestern and we are on
HALOs this week. The minimun age that a HALO can be applied to apediatric
is 2 YEARS.
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Call PMT@ 1 800 MANDKIND. They'll custom make a Halo if they don't have
one small enough.
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I havedone several of these on children less than a year old. Care is
extended to the suture lines, historically I use a full ring (not the
typical open back), 8-10 pins and torque to 2-3 in/lbs.
#1- PMT has a very small vest, infant ring andadapter blocks to
approximate the ring / vest angles. You may need to modify the vest distally
for flexion.
#2- custom make a TLSO and add the vest hardware to the TLSO.
#3- Apply a body cast and use a kit for this type of
application.
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We havesucessfully fit these patients with a bivalved custom molded minerva
when I wasworking at the University of Wisconsin. Patients of this age
SHOULD NOTbe fit with halos because of the flexibility of the skull.
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From my experience, I have found it extremely important toget a good mold and
grip on the pelvis in the tlso section. We also doroutine liner changes with
the physician present. Depending on the sizeof the patient you will most
likely need a custom ring. A closed ringworks best because you need lots of
options for pins.
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CallGeorge Mattingly C.O. of Hanger in Phoenix.
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Youmay want to give Nicole Parent at the O&P Dept. at the University
ofMichigan a call. I believe she has recently done a couple of halos
oninfants; I provide her with custom halo rings for infants from the
Bremerline. If you would like her number, just respond to this message or
youcan give me your number and I will ask her to call you.
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