title: Pinless halo in the pediatric population: indications and complications.
abstract: BACKGROUND
  The use of the conventional halo is accompanied by the possibility of serious complications, especially in the pediatric population. Complications could include penetration of pin into the skull, pin loosening, pin tract infection, cranial nerve palsies, and vest-related pressure sores. The noninvasive "pinless" halo was introduced in an attempt to mitigate these problems while retaining the effectiveness of the conventional halo. The purpose of this study is to determine the indications and complications related to pinless halo application.
  
  
  METHODS
  We retrospectively reviewed 61 patients, whose treatment included the use of a pinless halo device, presenting to our institution between 2004 and 2012.
  
  
  RESULTS
  There were 35 male and 26 female patients with an average age of 6.04 years. Indications of pinless halo application included postoperative immobilization for congenital muscular torticollis in 38 cases, conservative management of atlantoaxial rotatory subluxation in 11 cases, postoperative immobilization following cervical fusion in 10 cases, and immobilization for occipital condyle fracture in 2 cases. The average duration of the pinless halo application was 32.68 days. Thirteen patients had complications, among which major complications were seen in 2 patients, each of whom developed a pressure sore; one on the scalp and the other on the chest. Both the pressure sores responded to local treatment; however, 1 resulted in permanent alopecia.
  
  
  CONCLUSIONS
  The use of the noninvasive pinless halo was found to be safe with few complications in our study. The complications were infrequent and patients were compliant to treatment, indicating that this modality is patient-friendly. Effectiveness of this treatment in comparison with invasive halos and other cervical orthoses was not determined and is a limitation of this study.
  
  
  METHODS
  Level IV-Case series.
authors: Division of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA.
authors: Hooman
authors: H
authors: Bakhshi
authors: Indranil
authors: I
authors: Kushare
authors: Bibek
authors: B
authors: Banskota
authors: Christopher
authors: C
authors: Nelson
authors: John P
authors: JP
authors: Dormans
mesh_terms: D002648:Child; D005260:Female; D005592:Fracture Fixation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D006801:Humans; D004204:Joint Dislocations / Q000209:etiology / Q000517:prevention & control; D008297:Male; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods / Q000534:rehabilitation; D012189:Retrospective Studies; D013124:Spinal Injuries / Q000175:diagnosis / Q000601:surgery*; D013165:Splints / Q000009:adverse effects*; D014103:Torticollis / Q000151:congenital* / Q000601:surgery; D014143:Traction / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome