Halo Ring Application (Halo Gravity Traction)

Attire

Size 8 gloves — Biogel underneath + size 8 white gloves on top

Anesthesia

General anesthesia (or sedation + local in select cases).

Position

Supine, neutral head support. One team member stabilizes the ring while 1–2 place pins.

Equipment

• PMT halo ring (pediatric — open and closed options); sits ~1 cm from skin, just below widest skull diameter.
• Sterile halo pins — 2.5" and 3.0" (Shriners stock). 3.0 cm titanium pins typical.
• Calibrated torque screwdriver / breakaway wrench; pin locknuts.
• Chlorhexidine or iodine prep + sterile ointment; 1% lidocaine w/ epi, 25-g needle.
• Overhead pulley traction system + weights.

Ring alignment & marking

• Anterior: ~1 cm above eyebrow (outer ⅔), above orbital rim, below skull max circumference.
• Posterior: posterolateral at 4:00 and 8:00, diagonal to anterior pins, above ear helix, below skull equator.
• Mark sites with Betadine swab. Inject local through the ring pinholes (skin→periosteum).

Pin configuration & torque (by age)

• Infants/toddlers: 10–12 pins @ 1–2 in-lb (or finger-tight).
• School-aged: 6 pins @ 6 in-lb.
• Adolescents: 4 pins @ 6–8 in-lb.
• Dip pin tips in iodine; advance in opposing pairs for balanced, centered fixation; maintain ~1 cm scalp clearance; apply locknuts.

Safe zones / avoid

• Anterior: frontal sinus, supratrochlear/supraorbital/zygomaticotemporal nerves, superficial temporal artery, temporalis.
• Eyelid precaution: draw eyebrow down, eye tightly closed before advancing anterior pins (avoid orbicularis tethering).
• Posterior: no critical neurovascular structures.

Traction (HGT)

• Start 5 lb (younger) / 10 lb (older); increase 2–3 lb/day or ~10% body weight/week as tolerated.
• Target max 33–50% body weight. Confirm weight hangs free.
• Daily neuro exams — watch for over-distraction (CN VI palsy most common). Reduce/discontinue immediately for any neuro change.