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;=20
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?=20
c.. How long has the patient been in the halo, and what is his/her =
general condition neurologically?=20
d.. Have you seen evidence of either an infection at a skull pin site =
or of an impending pressure sore under the vest?=20
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. =20
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!
———————————————————————–
Contact Bremmer, they are the ones we get our Halos from and they have =
good instructions.
—————————————————————–
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. =20
——————————————–
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 (mpagano@USADATANET.ni )
————————————————
Please forward your fax number and I will send you the requested =
information. =20
I look forward to hearing from you soon.
Joe Johnson
International Sales Manager
PMT Corporation
952-470-0866
——————————————————————-
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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=20
