title: Orbital roof fracture and orbital cellulitis secondary to halo pin penetration: case report.
abstract: Study Design Case report. Objective To report and discuss a rare complication after a patient was treated conservatively with a halo vest. Methods A 51-year-old man sustained a hangman's injury of the C2 vertebra following a motor vehicle collision. He was treated conservatively in a halo vest appliance and following mobilization was discharged from the hospital. Two weeks after discharge, the patient presented to the emergency department complaining of proptosis, ptosis, diplopia, and pin loosening. He was readmitted to the hospital, the halo vest was removed, and urgent imaging studies including computed tomography scan and magnetic resonance imaging were performed. They revealed that one of the halo pins had penetrated the orbital roof with active infection of the extraocular soft tissues. In consultation with the ophthalmologist, he was treated conservatively with antibiotics for 10 days. Results His ophthalmologic complaints resolved gradually and his eye returned to normal appearance and function. In the meantime, he was immobilized in a sterno-occipital mandibular immobilizer brace. Conclusion Though rare, penetrating injuries after cranial pin insertion can occur. Halo devices must be applied by, or under close supervision of, experienced personnel to avoid such complications, and halo vests should be reviewed frequently to detect such incidents early.
authors: Department of Orthopaedics, Khoula Hospital, Mina al Fahal, Muscat, Sultanate of Oman.
authors: K Venugopal
authors: KV
authors: Menon
authors: Department of Orthopaedics, Khoula Hospital, Mina al Fahal, Muscat, Sultanate of Oman.
authors: Asif Esam
authors: AE
authors: Al Rawi
authors: Department of Radiology, Khoula Hospital, Mina al Fahal, Muscat, Sultanate of Oman.
authors: Sawsan
authors: S
authors: Taif
authors: Department of Orthopaedics, Khoula Hospital, Mina al Fahal, Muscat, Sultanate of Oman.
authors: Khalifa
authors: K
authors: Al Ghafri
authors: Department of Orthopaedics, Khoula Hospital, Mina al Fahal, Muscat, Sultanate of Oman.
authors: Kishore Kumar
authors: KK
authors: Mollahalli
keywords: cranial halo; halo vest; orbital cellulitis; penetrating orbital injury; proptosis; ptosis
references: J Spinal Cord Med. 2003 Fall;26(3):186-92
references: 14997956
references: J Neurosurg. 1986 Dec;65(6):762-9
references: 3772473
references: J Neurosurg. 2004 Apr;100(4 Suppl Spine):367-71
references: 15070146
references: Arch Orthop Trauma Surg. 2001;121(1-2):50-5
references: 11195118
references: Eur Spine J. 2009 Jul;18 Suppl 2:172-5
references: 18751739
references: Spine (Phila Pa 1976). 2009 Jul 1;34(15):1561-6
references: 19521274
references: Eur Spine J. 2009 Jul;18 Suppl 2:269-71
references: 19390875
references: Am J Orthop (Belle Mead NJ). 2005 Jun;34(6):271-6
references: 16060554
references: J Am Acad Orthop Surg. 2007 Dec;15(12):728-37
references: 18063713
references: Dysphagia. 2003 Winter;18(1):39-45
references: 12497195
references: Injury. 2010 Nov;41(11):1127-35
references: 20889154
references: J Bone Joint Surg Am. 1986 Mar;68(3):320-5
references: 3949826
references: J Bone Joint Surg Am. 2009 Jan;91(1):71-9
references: 19122081
references: Neurochirurgie. 2012 Dec;58(6):386-90
references: 22989701
references: J Bone Joint Surg Am. 1959 Jan;41-A(1):37-60
references: 13620686
references: Orthopedics. 2008 May;31(5):446
references: 19292320