title: Reduction of halo pin site morbidity with a new pin care regimen.
abstract: METHODS
  A retrospective analysis of halo device associated morbidity over a 4-year period.
  
  
  OBJECTIVE
  To assess the impact of a new pin care regimen on halo pin site related morbidity.
  
  
  BACKGROUND
  Halo orthosis treatment still has a role in cervical spine pathology, despite increasing possibilities of open surgical treatment. Published figures for pin site infection range from 12% to 22% with pin loosening from 7% to 50%.
  
  
  METHODS
  We assessed the outcome of a new pin care regimen on morbidity associated with halo spinal orthoses, using a retrospective cohort study from 2001 to 2004. In the last two years, our pin care regimen was changed. This involved pin site care using chlorhexidene & regular torque checking as part of a standard protocol. Previously, povidone iodine was used as skin preparation in theatre, followed by regular sterile saline cleansing when pin sites became encrusted with blood.
  
  
  RESULTS
  There were 37 patients in the series, the median age was 49 (range, 22-83) and 20 patients were male. The overall infection rate prior to the new pin care protocol was 30% (n=6) and after the introduction, it dropped to 5.9% (n=1). This difference was statistically significant (p<0.05). Pin loosening occurred in one patient in the group prior to the formal pin care protocol (3%) and none thereafter.
  
  
  CONCLUSIONS
  Reduced morbidity from halo use can be achieved with a modified pin cleansing and tightening regimen.
authors.affiliation: Spinal Unit, Department of Orthopaedics, Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: Hussain Anthony
authors.initials: HA
authors.lastname: Kazi
authors.forename: Marcus
authors.initials: M
authors.lastname: de Matas
authors.forename: Robin
authors.initials: R
authors.lastname: Pillay
keywords: Cervical spine; Orthosis; Spinal injury; Trauma; Tumour