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Halo Orthosis in Children

- Planning Pin Sites:
    - placement of skull pins in children requires preoperative CT scan of skull to assess thickness;
         - pins should avoid skull suture lines, and should generally not be placed in the temporal region or into the frontal sinus;
     - as in adults, avoid placing pins too far anterior (to avoid frontal sinus as well as supra-orbital nerves);
    - it is recommended that 4-6 pins be inserted to finger tightness, which is about 2-5 in/lb of torque;

- Positioning:
    - child should be placed on split matress which allow head to be placed in slight extension;

- Cautions:
    - due to thinness of the skull, upto 40% of pediatric patients will have complications related to halo;
    - halo is generally contra-indicated in patients less than 2 yrs;
    - re-tightening of loose pins is associated w/ penetration of inner table of skull and subsequent brain abscess

- ref:
    - Complications in children managed with immobilization in a halo vest.