title: Monitoring the use of halo fixation device through an assessment form.
abstract: OBJECTIVE
  To compare the use of the halo fixation device in our hospital before and after implementation of a new compliance protocol.
  
  
  METHODS
  From 2003 to 2008, 17 (47%) of 36 patients had dislodgement of their halo fixation device. All rings and vests and some of the pins were reused. Documentation of poundage assessment and change of skull pins before dislodgement was lacking. There was no protocol for assessing superstructure throughout the course of the application. To improve the standard of care, knowledge about the application of the halo fixation device in orthopaedic and orthotic departments was reinforced and compliance documented. From September 2008 to April 2010, 15 patients used the halo fixation device for cervical immobilisation. Patients were reminded to minimise shoulder shrugging and report any discomfort. Poundage checking was strictly observed during and after application. The integrity of the device was regularly checked by orthotists. The conditions of the skull pins, halo ring, and vest were also documented after removal.
  
  
  RESULTS
  Two (13%) of the 15 patients had ring dislodgement. One occurred a day after application owing to malposition of a posterior skull pin, and the other was related to a fall in a toilet at week 4. Both involved reused skull pins. 45% of the skull pins were new, whereas 44% were found defective after removal of rings. Compliance with the new assessment form was satisfactory.
  
  
  CONCLUSIONS
  Clinical audit improved outcome achieved with the halo fixation device. Reuse of titanium skull pins should be avoided. Re-torquing of the pin should be avoided when the tip is blunted or hooked. The new assessment form enabled compliance with the principle of application by orthotists and patients.
authors.affiliation: Spine and Rehabilitation Service, Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital, Hong Kong. hoch1@ha.org.hk
authors.forename: Chin-Hung
authors.initials: CH
authors.lastname: Ho
authors.forename: Ka-Kin
authors.initials: KK
authors.lastname: Li
authors.forename: Raymond Ping-Hong
authors.initials: RP
authors.lastname: Chin
authors.forename: Helen Wai-Man
authors.initials: HW
authors.lastname: Lee
authors.forename: William Yan-Yee
authors.initials: WY
authors.lastname: Kwong
authors.forename: Hung-Hei
authors.initials: HH
authors.lastname: Kwan
mesh_terms: D001858:Bone Nails; D002574:Cervical Vertebrae / Q000293:injuries*; D002985:Clinical Protocols; D004867:Equipment Design; D004868:Equipment Failure; D017743:Equipment Reuse; D006801:Humans; D009984:Orthopedic Fixation Devices