Pediatric Trauma Society

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How a Halo Orthotic Alters the Biomechanics of a Frontal Motor Vehicular Collision
*Eric A Sribnick1, Julie A Bing2, Carrie Rhodes1, Yun S Kang2, John H Bolte2
1Nationwide Children's Hospital, Columbus, OH; 2The Ohio State University, Columbus, OH

Background (issue):
Cervical spine injuries in children under 10 frequently involve the craniocervical junction. In patients too small for spinal instrumentation, treatment may involve a halo orthosis, and patients will frequently be discharged home in a halo. Little research has been done on the biomechanics of motor vehicular collisions involving children in halos. To better understand these safety concerns, we applied a halo to an appropriately sized crash test dummy on an acceleration sled to recreate a frontal motor collision.
Methods:
For the tests, a Hybrid III 3-year-old anthropomorphic test device (ATD) was instrumented with head and chest accelerometers, head angular rate sensors, a six-axis upper neck load cell, and a chest linear potentiometer. Tests were conducted on an acceleration sled, and kinematics were recorded with high speed video. Testing variables were halo or no halo and standard backless booster seat or travel vest (RideSafer).
Findings:
The halo reduced cervical flexion and extension; however, halo use was associated with increased head axial rotation rate, especially when utilizing a halo with a backless booster. Increased cervical distraction forces were noted with the halo, and this was especially increased when used in combination with the travel vest.
Conclusions (implications for practice):The biomechanics of a motor vehicular collision involving a child may be dramatically altered with a halo, as modeled by an acceleration sled test. While cervical flexion and extension are reduced, head rotation is increased. Immobilization from a halo plus a travel vest increases cervical distraction forces, which would not be ideal in a patient with a craniocervical injury.


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