any child with neck pain, associated head or facial trauma, loss of consciousness & appropriate history e.g. high speed MVA must be considered for immobilization
in children younger than 6 years of age
split mattress technique which allows for the thorax to sit higher than the occiput is important
Halo technique
altered from the adult technique by using 4 pins anterolateral ana 4 pins posterolateral
child under 6 years of age
have variable thickness to the skull & a CT scan may be helpful in the identification of adequate bonestock
halo is held just below the greatest curvature anteriorly – typically above the eyebrows & 1 cm above the ears
anterior pins are placed on the outer 2/3 of the orbit
posterior pins are placed diagonal to the anterior & below the equator of the skull
Young child – finger tighten
Older child – 2lbs of torsion
Adolescent – 4 lbs
Adult – 6-8 lbs of torsion
pins are secured to the halo & then to the appropriate vest or body cast
Many complications of Halo
Local pin care with daily iodine cleansing
Superficial pin tract infections are managed with local wound care & PO antibiotics
Severe infections are treated with pin removal & antibiotics
Dural puncture is managed by removal of pins & 5 days of antibiotics
