[Halo-fixator vest--indications and complications].
Over the period between 06/00 and 03/03, 41 patients with different injuries of the upper cervical spine were treated by a halo fixator and were statistically recorded. The collective showed different injury patterns, 2 fractures of occiput condyles (5%), 3 Jefferson fractures (7%), 1 combined injury of the odontoid process and an atlas fracture (2%), 32 odontoid fractures (78%), 2 hanged-man-fractures Typ Effendi II (5%) and one case of pathologic fractures from the 2. to the 4. cervical vertebral body based on a plasmocytoma (2%). 31 of 41 patients could be examined for a follow up; 40 complete medical histories were well documented and could be analysed. As complications we had screw loosening in 6 cases (15%), a complete tear out of screws in 2 cases (5%). One patient took the halo away by himself two times, so after the second time surgical stabilisation was performed (2,5%). One case of intracranial penetration of a screw happened after the patient fell down in an accident with the halo (2,5%). Infection of the screw pins appeared in 4 cases (10%) and we had 2 cases of skin necrosis (5%). A second reduction after redisplacement was necessary in 8 cases (20%). 23 patients suffered from pain at the insertion of the screws (75%) and 18 patients complained of pressure in the head (58%). On the question of the comfort of this kind of therapy answered 18 patients with "intolerable" (58%), 10 patients with middle (32%) and 3 patients with tolerable (10%). Despite of the large number of different complications and the miscomfort of a halo fixator we think that there are still indications for treatment of special injuries of the upper cervical spine with a halo fixator. One important aspect is the lack of adequate alternatives even with regard to the biomechanical stability.
Strohm
P C
PC
Klinikum der Albert-Ludwigs-Universität Freiburg, Department für Orthopädie und Traumatologie. strohm@ch11.ukl.uni-freiburg.de
Müller
Ch A
ChA
Köstler
W
W
Reising
K
K
Südkamp
N P
NP
D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws; D002574:Cervical Vertebrae / Q000293:injuries* / Q000601:surgery; D019544:Equipment Failure Analysis; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D017102:Fracture Healing / Q000502:physiology; D005598:Fractures, Spontaneous / Q000601:surgery; D019416:Head Movements / Q000502:physiology; D006801:Humans; D008297:Male; D009777:Occipital Bone / Q000293:injuries*; D009809:Odontoid Process / Q000293:injuries / Q000601:surgery; D010146:Pain / Q000209:etiology; D017060:Patient Satisfaction; D010954:Plasmacytoma / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D012887:Skull Fractures / Q000601:surgery*; D016103:Spinal Fractures / Q000601:surgery*; D013125:Spinal Neoplasms / Q000601:surgery