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Authors of section


Ronald Lehman, Daniel Riew, Klaus Schnake

General Editor

Luiz Vialle

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Halo vest

1. Preliminary remark

The halo ring can be used for traction and closed reduction of fractures.

Closed reductions should only be performed in conscious patients or in OR prior to surgery.

The halo ring can be placed under local anesthesia in conscious patients. The patient is in a supine position on a stable surface.

atlanto occipital dissociation

The halo ring can be connected to a halo vest to provide stability following closed reduction.

The halo vest has to be sized prior to the procedure.

anderson dalonzo type iii

2. Halo ring installation

Halo size

The circumference of the patients head is measured and an appropriately sized halo ring is selected.

The ring should allow 1-2 cm clearance from the skull.

temporary halo and traction

Temporary halo fixation

The appropriate halo ring is placed with temporary stabilization pins.

temporary halo and traction

Screw placement

Anterior screws are inserted 1 cm superior to the lateral 1/3 of the eyebrows.

The eyelids should be kept closed.

temporary halo and traction

The posterior screws are placed approximately 5 cm posterior to the ear.

Ideally any posterior screw should be directed towards its contralateral anterior screw, and vice versa.

Care should be taken to prevent contact between the halo ring and the ears.

temporary halo and traction

For adults at least four screws are necessary. For children, 6-8 screws are recommended. The halo ring should be placed inferior to the equator of the skull.

temporary halo and traction

Halo fixation

The pin sites are cleaned with a disinfectant and the skin and periosteum is infiltrated with local anaesthesia.

During insertion of the screws, the eyelids of the patient should be kept closed. If screws are inserted into the supraorbital rim with the eyelids open, the patient may not be able to close the eyelids postoperatively.

atlanto occipital dissociation

Initially the permanent screws are tightened by hand, followed by the use of a torque screw driver. Opposing screws are tightened sequentially 1, 2, 3, and 4.

For adults the maximum torque should be set to 0.56 kg/cm3 and 0.28 kg/cm3 for children.

temporary halo and traction

3. Reduction

Closed reduction is performed under image intensifier. Extension or flexion is applied depending on the position of the fragments. This is followed by compression. Reduction should not include traction maneuvers.

4. Attachment to halo jacket

After reduction is achieved and confirmed on X-rays, the halo ring is attached to a halo jacket. Maximum stability is achieved when rods are symmetrical and parallel.

halo vest

Postoperative X-ray control

X-rays are performed and the position of the spine is checked.

Screw site care

As the screws loosen over time, they should be re-torqued after 24h, 3 days, and then weekly until the halo is removed.

Screw sites should be cleaned daily and the screws replaced in case of loosening or signs of infection.

anderson dalonzo type iii