Abstract
SUMMARY
We designed less expensive halo vest brace using an Ilizarov ring and a threaded rod, which is as effective as the normal halo vest. It can be used in any orthopedic set-up.
Introduction
The halo vest brace is an orthotic device which is used for cervical and dorsal skeletal traction and immobilization. Its function is to exert traction and immobilize the cervical spine. It is indicated mainly for unstable fractures of cervical spine/dorsal spine, atlanto-axial dislocation, compression fractures of cervical/dorsal spine, pathological fractures, TB, tumours and scoliosis. It is attached to the skull with the help of a ring and pins and connected to PVC jacket with four adjustable uprights. The halo apparatus has been shown to be most effective non-surgical method for stabilizing a fractured spine. 1
In developing countries hospitals often have resources and limited bed space and patients are discharged as possible after receiving best available treatment. The conventional halo brace is too expensive for poor patients, so we made a less expensive halo brace using a recycled Ilizarov ring and a threaded rod, which proved affordable and effective. It can be used in any orthopedic set-up.
Case report
A 25-year-old woman with an alleged history of a fall from tree presented to the emergency with pain in neck region following trauma to the neck region .On examination, there was tenderness in cervical region from C1 to C3, without neurological deficit. No other injuries were noted. On X-ray no bone injuries were detected. A computerized tomography scan showed a fracture of the anterior and posterior arches of the C1 vertebrae without any evidence of canal compromise. Clinicoradilogically it was diagnosed as a C1 fracture without neural deficit. She was treated with a head halter traction for a period of six weeks. As the patient could not afford the conventional halo vest brace, we created an inexpensive version in own workshop using recycled material.
She was attended regular follow up every six weeks. After four and a half months follow up, no evidence of pin track infection and pin loosening was noted. At the end of six months the halo vest was removed, soft collar applied and neck was mobilized. In her whole course of treatment no neural deficit developed.
How make the inexpensive halo vest brace
Material needed
Four two-hole male posts, four 40 cm full-threaded connecting rods, four 6 cm full-threaded connecting rods with one end sharpened – at the other end a plain nut is welded onto a 5/8th ring placed around the circumference of the head piece, the anterior chest piece and the posterior back piece.
Inserting the skull pins
Four points are marked – two points 1 cm over the lateral edge of supraorbital region, and the other two in line with the two mastoids about 1 cm above superior border of pinna. Next, the four 6 cm full-threaded connecting rods – one end of which has been sharpened with a plain nut welded to the other end so that it could be tightened with a spanner – are inserted perpendicular to the skull just crossing the outer table by stopping at the resistance offered by the inner table or stopping at the threaded area of the rod which allows only a fixed length of the rod to go into the skull.
Fixing the ring on the rods
One recycled Ilizarov 5/8th ring is fixed by the four two-hole male posts to the four 40 cm full-threaded connecting rods already inserted into the skull.
Wearing the vest
The vest part was designed using an anterior chest piece and a posterior back piece; both were connected around the shoulder in our workshop and should be worn as shown in Figure 1.
An inexpensive version of the halo vest brace
Fixing the ring to the vest
The ring is fixed to the vest part using 40 cm full-threaded connecting rod and nuts.
Discussion
Our version of the halo vest was designed with simplicity and affordability in mind. It is extremely lightweight for added patient comfort. The unique locking mechanism permits positive and secure positioning and allows assess to the area for emergencies and hygiene. The combination of the Ilizarov ring and the threaded rods used in this device produces artifact-free image quality. The low profile permits unobstructed medial-lateral and anterior-posterior X-ray. One complication was an infection at the site of the halo pin at the end of 26 weeks but no pressure sores developed under the body cast. This is a biomechanically stable device and the patient was observed to be walking, sleeping and sitting without discomfort. This can be used for three-dimensional deformity corrections which can be obtained in a controlled fashion. The patients can be allowed to get out of bed to sit and walk. The spinal distraction with halo-cast traction is a useful adjunct in the treatment of selected complex cervical and high thoracic deformities. 2 We recommend this device using the Ilizarov ring and rods for an alternative halo vest brace as it is less expensive to produce, and can reduce the hospital stay. It is as effective as the conventional halo vest brace.