Neurosciences - Treatment in Halo and Jacket

About your fracture

You have been admitted to hospital as you have sustained a fracture in your neck, this may also be referred to as a fracture in your cervical spine.

The bones in the cervical region (neck) are numbered from C1-C7 and are stacked on top of each other, they connect at the top to your skull and at the bottom around the top of your shoulders to the next section of your spine.

The first two bones C1 and C2 look different from all the other bones and can be referred to as the Atlas and Axis, the way these two bones fit together with a peg is how your head manages to rotate separately from the rest of your body.

As this section of the spine is normally very mobile the safest way to keep your fractured bones still whilst they heal is to fit you with a halo and jacket, this will prevent you from moving your head.

The exact type of fracture you have will be explained to you by your doctor.

Fractured spinal bones (vertebrae) usually take about 12 weeks to heal.

Fitting of the Halo and Jacket

You will be measured on the ward by one of the team, measurements will be taken around your head and around the widest part of your chest where your sternum (breastbone) is.

We will then know the best size to fit you with to make sure you are as comfortable as possible when wearing it.

The sheepskin lining of the jacket needs to be applied directly onto your skin so you will need to remove any underwear.

Often the halo and jacket can be fitted on the ward, but we occasionally may take you to an operating theatre, this is more likely if we think you will need x-rays to check the position of the bones.

You do not need a general anaesthetic and you will stay awake.

The doctor will inject local anaesthetic at four points around your skull where the pins are placed, this can cause some swelling and we will ask you to keep your eyes closed at this time.

Once the local anaesthetic is working, we will insert and tighten the pins which will hold the ring in place.

Once this is done the jacket is fitted, the bars are attached and then everything is tightened to ensure a good fit. There is a feeling of tightness around the head when the pins are tightened but this feeling should settle soon.

After application

You will have an x-ray to check that the fracture is in a good position to heal.

You can normally get out of bed and move around soon after, though you may need some help for the first day or two with learning how to do this and finding your balance. Physiotherapy can support you with this if you are finding it difficult.

You may have a headache later that day and we will make sure we give you painkillers to help with this.

The next day it will be necessary to recheck that the screws are tight as sometimes once the initial swelling settles some adjustments are needed.

We will teach you how to clean your pin sites daily and we will explain the follow up plan before you are discharged.

You will be given contact details of the spinal nurses who can be contacted if you have any issues.

Wearing the Halo and Jacket

General information

Smoking or using any nicotine products delays bone healing, we can refer you to services to help you quit smoking.

It is important to eat a healthy diet with lots of protein, calcium and vitamin D. It may help to take a vitamin D supplement. We can check your levels to see if you need supplements.

Normally you will need to wear the halo and jacket for 12 weeks.

You often need to continue to wear a collar for a period of time once the halo is removed.
 
You cannot drive or ride a bike in a halo. We would advise you remain off work.

We do not recommend any exercise however walking around is fine.

You will have x-rays during the 12 week period to monitor for any issues and assess healing. A scan may be performed as well if needed during this period or before the halo comes off.

You will come back for regular review to the clinic during this 12 week period and we may also need to retighten the pins.

Care tips and general information

It is useful to always sit upright when eating, make sure you chew small amounts at a time as you may have trouble swallowing.

It can be difficult to find a comfortable sleeping position, we would recommend using several pillows or a bean bag to raise you up in bed, our patients have told us that a rolled-up towel through the bars helps support the back of your neck.

You can sleep on your side, but this may not be easy, again you will need to use pillows as support.

The jacket needs to be kept dry, we would recommend using wet wipes and a towel to wash your body, a handheld shower can be used to wash your lower body.

We are happy to supply you with extra cleaning solution and gauze if needed. Please report any increased worsening pain, loosening of the halo or if there is any obvious sign of infection to the contact details provided.

After removal

Once a scan has been taken and the consultant is satisfied that there is evidence of healing, we will plan to remove the halo. This is done in the clinic at hospital.

The pin sites do not need suturing afterwards and will heal quickly.

You will most likely need to continue to wear a collar for 4-6 weeks after removal.

We can refer you to physiotherapy as it is common to have stiffness and weakness to the muscles in your neck and shoulders.

You may find the link below useful

https://dpleblanc.wordpress.com/2015/09/29/how-i-lived-with-a- cage-over-my-head-aka-halo-brace/

The spinal nurses can be contacted on the below numbers:
0161 2060194/07759719869
Email Kelly.jackson@nca.nhs.uk