Within whole populations the use of halo bracing is relatively rare but for those treated with spinal disorders, particularly trauma, it is quite a common occurrence. Managing the care of a patient in a halo brace can be challenging. It represents a very obvious and complex health care intervention that requires nurses to offer patients considerable support. A significant proportion of these needs are informational. Show
The purpose of this paper is to help nurses in general orthopaedic settings and those new to working with spinal disorders to better understand the needs of this client group by: 1.Describing the development and application of the halo brace apparatus 2.Identifying the potential problems and hazards that halo bracing can generate 3.Discussing what advice patients living with the halo brace might need. Information is drawn from the medical literature, available written patient information and the very limited nursing literature on the topic as well as the author’s clinical experience. Section snippetsDevelopment and application of the halo braceHalo traction apparatus was developed during the late 1950s superseding the use of plaster of Paris jackets as a technique for immobilising the cervical spine. Halo apparatus (pictured in Fig. 1) has the advantage of being lighter, more comfortable, less obstructive to medical imaging, and, fundamentally more effective in immobilising the spine (Thompson, 1962). The design has been continually developed and refined since its inception (Garfin and Ibrahim, 1997) and it is now a very common Patient safety, avoiding hazards associated with halo bracingAs with all care the first priority must be patient safety and risk management. This section of the paper discusses the likely potential hazards arising from halo bracing. Generally halo traction is a safe and uneventful therapy. There is, however, a range of potential problems that the patient taking on self-care needs to be made aware of and enabled to respond appropriately to. These are pin site infection, pin loosening, halo displacement and pressure ulcers and skin damage. Establishing the Advice for living with a halo braceTypically patients require a halo brace for around 12 weeks to allow for healing of bone and soft tissues, though they can be worn for longer. Wearing this device for such a long period requires adjustments to lifestyle and the way that virtually all self-care needs are met. Nurses have a significant role in facilitating this adjustment through appropriate advice and guidance. The advice for patients is summarised in Table 3 and it is structured around the universal health care needs identified ConclusionThis paper has discussed the common applications of halo traction and identified the need to advise patients in halo braces prior to discharge. The advice patients need covered two main topic areas; managing the potential problems and risks of halo traction and advising patients on ways to live with the brace in situ. The key risks identified were pin site infection or loosening, halo displacement and pressure ulcer. A summary of advice that could be offered to patient wearing a halo brace was First page previewOpen this preview in PDF  Click to open first page preview Open this preview in PDF References (25)
Outcome of halo immobilisation of 104 cases of cervical spine injuryScottish Medical Journal(2004) Epidemiology of incident spinal fracture in a complete populationSpine(1996)
Research article Journal of Psychosomatic Research, Volume 79, Issue 6, 2015, pp. 574-579 Show abstractNavigate Down Limb length discrepancy (LLD) is common in patients with developmental dysplasia of the hip (DDH) and may influence the psychological status of these patients. The present study aims to investigate depression and anxiety in DDH patients with different extents of LLD and to assess the effect of LLD correction on these two psychological factors. 161 patients with DDH were recruited and divided into two groups based on whether they could perceive LLD preoperatively. The patients who could not perceive LLD were assigned to group N, and those who could perceive LLD were assigned to group P. Depression/anxiety, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and LLD were assessed one week before, six months and two years after total hip arthroplasty (THA). Depression and anxiety were significantly higher in group P patients compared to group N patients. The patients in group N presented significant improvement in depression and anxiety six months after arthroplasty, while DDH patients in group P did two years after arthroplasty. Correlation analyses revealed their improvement was associated with pain relief and improved hip function in both groups of patients and was also related to changes in the perception of LLD in group P patients. Depression and anxiety levels were higher in DDH patients with perceived LLD. Their improvement was related to pain relief and improved hip function following THA. In DDH patients with perceived LLD, a change in the perception of LLD also played a part in their improvement. Research article The Journal of Foot and Ankle Surgery, Volume 55, Issue 2, 2016, pp. 379-382 Show abstractNavigate Down Syndesmotic injuries are challenging in diagnosis and management as delays in treating the injury lead to poorer functional outcomes. In this case report, we discuss management of an untreated Maisonneuve fracture. To our knowledge, our technique of using a composite braided suture with internal buttons fixed from the talus to the medial malleolus to supplement our syndesmotic repair has not previously been described. Research article The Journal of Hand Surgery, Volume 40, Issue 12, 2015, pp. 2401-2409.e8 Show abstractNavigate Down To examine the utilization and cost of post–acute care following isolated distal radius fractures (DRFs) among Medicare beneficiaries. We examined utilization of post–acute care among Medicare beneficiaries who experienced an isolated DRF (n = 38,479) during 2007 using 100% Medicare claims data. We analyzed the effect of patient factors on hospital admission following DRF and the receipt of post–acute care delivered by skilled nursing facilities, inpatient rehabilitation facilities, home health care agencies, and outpatient occupational therapy/physical therapy for the recovery of DRF. In this cohort of isolated DRF patients, 1,694 (4.4%) were admitted to hospitals following DRF, and 20% received post–acute care. Women and patients with more comorbid conditions were more likely to require hospital admission. The utilization of post–acute care was higher among women, patients who resided in urban areas, and patients of higher socioeconomic status. The average cost per patient of post–acute care services from inpatient rehabilitation facilities and skilled nursing facilities ($15,888/patient) was significantly higher than the average cost other aspects of DRF care and accounted for 69% of the total DRF-related expenditure among patients who received inpatient rehabilitation. Sociodemographic factors, including sex, socioeconomic status, and age, were significantly correlated with the use of post–acute care following isolated DRFs, and post–acute care accounted for a substantial proportion of the total expenditures related to these common injuries among the elderly. Identifying patients who will derive the greatest benefit from post–acute care can inform strategies to improve the cost efficiency of rehabilitation and optimize scarce health care resources. Therapeutic III. Research article The Journal of Foot and Ankle Surgery, Volume 55, Issue 2, 2016, pp. 383-386 Show abstractNavigate Down We present a case of tibial nerve impingement by an anteroposterior screw inserted for stabilization of a posterior malleolar fracture. This specific complication has not previously been described in published studies, although numerous reports have described various forms of peripheral nerve entrapment. We discuss the merits of fixation of these fractures using a posterolateral approach. Research article Injury, Volume 48, Issue 2, 2017, pp. 270-276 Show abstractNavigate Down Tension-band wire fixation of patellar fractures is associated with significant hardware-related complications and infection. Braided polyester suture fixation is an alternative option. However, these suture fixations have higher failure rates due to the difficulty in achieving rigid suture knot fixation. The Arthrex syndesmotic TightRope, which is a double-button adjustable loop fixation device utilizing a 4-point locking system using FibreWire, may not only offer stiff rigid fixation using a knotless system, but may also obviate the need for implant removal due to hardware related problems. The aim of our study is to compare the fixation rigidity of patella fractures using Tightrope versus conventional tension-band wiring (TBW) in a cadaveric model. TBW fixation was compared to TightRope fixation of transverse patella fractures in 5 matched pairs of cadaveric knees. The knees were cyclically brought through 0–90° of motion for a total of 500 cycles. Fracture gapping was measured before the start of the cycling, and at 50, 100, 200 and 500 cycles using an extensometer. The mean maximum fracture gapping was derived. Failure of the construct was defined as a displacement of more than 3 mm, patella fracture or implant breakage. All but one knee from each group survived 500 cycles. The two failures were due to a fracture gap of more than 3 mm during cycling. There was no significant difference in the mean number of cycles tolerated. There was no implant breakage. There was no statistical significant difference in mean maximum fracture gap between the TBW and TightRope group at all cyclical milestones after 500 cycles (0.3026 ± 0.4091 mm vs 0.3558 ± 0.7173 mm, p = 0.388). We found no difference between the TBW and Tightrope fixation in terms of fracture gapping and failure. With possible lower risk of complications such as implant migration and soft tissue irritation, we believe tightrope fixation is a feasible alternative in fracture management of transverse patella fractures. Research article Journal of Oral and Maxillofacial Surgery, Volume 73, Issue 10, 2015, pp. 1917.e1-1917.e6 Show abstractNavigate Down This report describes the case of a 74-year-old man who had been diagnosed with Charcot-Marie-Tooth disease as a child. Because the patient had serious motor and sensory neuropathy associated with his disease, special anesthetic and surgical recommendations had to be considered before he underwent general anesthesia to repair his mandibular fracture. Repair of the mandible was performed under general anesthesia with a nasal endotracheal tube and the use of the nondepolarizing muscle relaxant rocuronium. Open reduction and internal fixation through extraoral approaches were used to fixate the displaced right subcondylar and symphyseal fractures. A closed reduction approach using maxillary fixation screws and a mandibular arch bar with light elastic guidance was used to treat a nondisplaced fracture of the left mandibular ramus. Rigid fixation allowed for avoidance of a period of intermaxillary fixation. General anesthesia and muscle relaxant were administered without complication. Treatment of bilateral mandibular fractures with combined open and closed approaches resulted in restoration of premorbid occlusion and masticatory function. Repair of mandibular fractures under general anesthesia appears to be a safe procedure in patients with Charcot-Marie-Tooth disease when appropriate anesthetic and surgical methods are used. |
