Halo-thoracic

Halo-thoracic

Richard Z

3/2/2005

Responses as discussed. Please all who helped accept my sincere thanks for willing assistance. Richard Ziegeler (p&o)

I am the Sales Manager for DePuy Spine in the US; my main product is the Bremer Cervical Halo Bracing System. Please tell me exactly what your situation is, and what your primary questions are, and I can probably help you out. I need clarification on the following:
  a.. What brand halo is the patient wearing? Possibilities include Bremer, PMT, and Jerome halos;
  b.. Your message line says Thoracic Halos, but halos are almost 100% cervical spine-related. Does this patient have both a cervical AND thoracic injury?
  c.. How long has the patient been in the halo, and what is his/her general condition neurologically?
  d.. Have you seen evidence of either an infection at a skull pin site or of an impending pressure sore under the vest?
  e.. Lastly, does the patient complain of any pain, movement, looseness, or clicking (at a skull pin site) of any sort?
I look forward to helping you, Richard, if you have not already been helped by someone on the listserve; they are a good group when it comes to assisting fellow orthotists.

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Try a colleague of mine Ashley Du Toit in New Zealand

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Depends on who makes it.

PMT & Bremmer are the most popular in these parts. (Texas)

Basically, DO NOT over tighten the pins that go through to the skull. You can pierce the bones and spinal fluid (CSF) can leak out. Not a good thing.

I would torque the superstructure to 24-18 ft. lbs., and the pins not past 8 pounds. As protocol we always return 24 hours past the initial application and re-torque the HALO ring and superstructure. HOWEVER, ONLY re-torque the HALO RING ONE TIME on the first returning visit.. Otherwise you will puncture the cranium and cerebral-spinal fluid will leak out. The superstructure can be safely re-torqued anytime if you hear creaking or it seems loose.

If you have any doubts about the ring or structure call the NS or the Ortho guys. It is better to be careful than wish you had been!!!

Back when the Halo's were first designed they were placed with only finger strength...approximately 8 lbs of ft. pound torque. On an adult we use 4 screws/pins. On a child use 8 pins and only torque to 4 ft/pounds. Keep the ring a thumb width above the most superior aspect of the ear and a 1/4 - 1/2 above the eyebrow. Make sure the patient has the eyes closed when the pin is placed so they eye lid can close all of the way! If the person ahs a sloping forehead make sure the ring is placed at the appropriate equatorial plane so the ring won't slough-off!
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Contact Bremmer, they are the ones we get our Halos from and they have good instructions.
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You can mail any of the major manufacturer's of the halo orthoses like Bremmer, PMT, and Jerome. Otherwise adjusting is done with a specific purpose in mind. You would have to be more specific about what adjustment is needed for what problem. You must now the abilities of whatever system you use and apply that to your adjustment goal. Inspections are different. Each portion of the halo appartus needs to fit and function within certain ranges. The manufactures will point some of these out. Maybe the atlas of orthotics. For my particular case it has come from my more experienced co-workers. We apply more than 200 a year and have been doing it for 30 years. If you want I can send you some guidelines that we teach at our national education fair for Hanger Orthotics.

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My name is Michael Pagano and I am a student member studying orthotics at the Newington Certificate Program. We have just completed our second week in the semester and I am trying to prepare for a debate presentation on the arguments for using a halo system to manage a high cervical fracture. I am in the process of conducting other formal research but would greatly appreciate any input from professionals across the country who have experience and knowledge to share, as well as aid my learning of spinal orthotics. Thank you for any help you can provide.

Sincerely,
Michael Pagano ( <Email Address Redacted> )

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Please forward your fax number and I will send you the requested information.

I look forward to hearing from you soon.

Joe Johnson
International Sales Manager
PMT Corporation
952-470-0866
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best place to start is the instruction manual that comes with most if not all Halo's. The most important thing to remember is that the skull pins are not to be retourqued after the original retorque 24 hours after fitting. We had one of our Orthopedic residents retourque some pins after a week. The pin sites were infected, and the resident ended up penetrating a sinus. The resident actually had two things wrong, retourque instead of remving and repositioning the pins and the pins were in the wrong postion originally. That's what happens when the physcians won't listen...

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