3 results
16 - Spine fractures
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- By Peter Millner, Leeds General Infirmary University Hospital
- Edited by Peter V. Giannoudis, Hans-Christoph Pape
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- Book:
- Practical Procedures in Orthopaedic Trauma Surgery
- Published online:
- 05 February 2014
- Print publication:
- 06 February 2014, pp 426-450
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- Chapter
- Export citation
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Summary
Indications
Halo devices are used in a variety of trauma settings, including:
Reduction of cervical spine facet subluxations and dislocations (usually via axial traction applied through the halo).
Stabilization of non-displaced cervical spine fractures.
Post-reduction stabilization of cervical spine fractures, subluxations and dislocations.
Temporary stabilization of a cervical spine injury, prior to definitive surgical treatment, or to facilitate safe transfer of the patient to a specialist spinal centre.
If the patient is physically able to mobilize, the halo can be attached to a ‘vest’. The vest may be a custom-made plaster or fibreglass orthosis, or one of the readily available ‘off-the-shelf’ devices. Several orthopaedic implant manufacturers market combinations of haloes and vest orthoses, in a range of sizes. The most useful halo and vest devices contain no ferrous components and are therefore MRI-compatible, permitting scanning of the patient after application.
Preoperative planning
Most halo and halo–vest systems are available as pre-packed kits containing all of the necessary implants and tools for halo application and subsequent attachment of the halo to a detachable vest. A careful check of the manufacturer’s kit inventory against the kit components and instruments should be done in every case; do not assume that even a pre-packed kit will be complete! If the halo is to be used for ambulatory cervical spine stabilization a suitably sized orthosis (vest) is selected. Standard antiseptic skin preparation solutions should be available. If not supplied in the halo kit, a small pointed scalpel will also be needed.
Measure head circumference using a tape measure and select the smallest possible halo size (Fig. 16.1.1).
The halo selected should permit an air gap of approximately 10 mm between the inner aspect of the halo and the largest circumference of the skull, measured as shown in Fig. 16.1.2.
13 - Examination of the spine in childhood
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- By Ashley Cole, Sheffield Children’s Hospital, Sheffield, Peter Millner, Leeds General Infirmary
- Edited by Nick Harris, Fazal Ali
- Foreword by Mark D. Miller, James Madison University, Virginia
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- Book:
- Examination Techniques in Orthopaedics
- Published online:
- 05 June 2014
- Print publication:
- 09 January 2014, pp 190-197
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- Chapter
- Export citation
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Summary
Introduction
The spectrum of conditions of the spine in children includes spinal infection, trauma, tumours, spondylolysis and spondylolisthesis, the adolescent disc syndrome, as well as spinal deformities such as scoliosis.
The clinician should be alerted to the quality and site of any painful spinal symptoms, in terms of whether or not it is activity-related and if there is any neuropathic pain. Worrying symptoms include night pain causing disturbed sleep, unremitting pain requiring regular analgesia and pain interfering with enjoyable activities. The younger the patient, the more likely it is that any spinal tumour is neoplastic, with 75% of spinal tumours in the under-6s being malignant, contrasting with less than 33% in over-6s who have spinal tumours. The benign but painful osteoblastoma and osteoid osteoma occur principally around the thoracolumbar junction and the pain is typically relieved by non-steroidal anti-inflammatory drugs. Although pain is a cardinal feature of spinal malignancy, present in 46–83% of cases, only about one in three cases will present purely with pain and two-thirds will present with neurological problems, such as radicular pain, muscle wasting and weakness and/or a limp. Most children with an underlying neurological or neuromuscular condition will already have a diagnosis, and a previously fit and healthy child who develops new weakness and/or a limp should be suspected of having a spinal tumour until proven otherwise.
Fractures of the cervical spine
- from Chapter 15
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- By Peter Millner, St James’s University Hospital
- Peter V. Giannoudis, St James's University Hospital, Leeds, Hans-Christian Pape, University of Pittsburgh
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- Book:
- Practical Procedures in Orthopaedic Trauma Surgery
- Published online:
- 05 February 2015
- Print publication:
- 14 December 2006, pp 269-282
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- Chapter
- Export citation
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Summary
APPLICATION OF A HALO AND HALO-VEST FOR CERVICAL SPINE TRAUMA
Indications
Halo devices are used in a variety of trauma settings, including:
Reduction of cervical spine facet subluxations and dislocations (usually via axial traction applied through the halo).
Stabilization of undisplaced cervical spine fractures.
Post-reduction stabilization of cervical spine fractures,\ subluxations and dislocations.
Temporary stabilization of a cervical spine injury, prior to definitive surgical treatment, or to facilitate safe transfer of the patient to a specialist spinal centre.
If the patient is physically able to mobilize, the halo can be attached to a “vest”. The vest may be a custom-made plaster or fibre-glass orthosis, or one of the readily available “off-the-shelf” devices. Several orthopaedic implant manufacturers market combinations of haloes and vest orthoses, in a range of sizes. The most useful halo and vest devices contain no ferrous components and are therefore MRI-compatible, permitting scanning of the patient after application.
Pre-operative planning
Most halo and halo-vest systems are available as prepacked kits containing all of the necessary implants and tools for halo application and subsequent attachment of the halo to a detachable vest.Acareful check of themanufacturer's kit inventory against the kit components and instruments should be done in every case; do not assume that even a pre-packed kit will be complete! If the halo is to be used for ambulatory cervical spine stabilization, a suitably-sized orthosis (vest) is selected. Standard antiseptic skin preparation solutions should be available. If not supplied in the halo kit, a small pointed scalpel will also be needed.