How is the halo skeletal fixator applied

The patient is placed supine with the head position controlled by the physician in charge (Fig. 18-10). The correct ring size (permits 1-2 cm of circumferential clearance around the skull) and vest size are determined. Critical measurement to determine correct vest size include:

1. Waist circumference

2. Chest circumference at level of xiphoid

3. Distance from shoulder to iliac crest

Pin sites are identified. The skin is cleaned with Betadine, and pin sites are injected with 1% lidocaine. The patient is instructed to keep the eyes closed during placement of the anterior pins to prevent skin tension in the eyebrow area, which could cause difficulty with eyelid closure. Anterior pins are placed 1 cm above the orbital rim, below the equator (greatest circumference) of the skull, and above the lateral two thirds of the orbit. This pattern avoids the temporalis muscle laterally and the supraorbital and supratrochlear nerves and frontal sinus medially. Posterior pins are placed opposite the anterior pins at the 4 o'clock and 8 o'clock positions. The pins are tightened to 8 in-lb (0.9 Nm) in adults. The vest is applied, and the upright posts are used to connect the ring to the vest. Cervical radiographs are obtained to check spinal alignment. The pins are retightened with a torque wrench once at 24 to 48 hours after initial application. The pin sites are cleaned daily with hydrogen peroxide.

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