Final Exam SCOM

When should you use a Halo?

any unstable upper cervical fractures

when should you not use a Halo?

severe facial/chest trauma, old age

when placing the ring, the ring should be ___ above the top of the ear.

1 cm

in placing the ring, the ring should be ____ between the skull and the ring.

½ “

in placing the ring, the ring should be ___ the equator of the skull

below

in placing the pins, the pins should be ___ above the eyebrow

1 cm

in placing the pins, the pins should be ___ of the eye socket.

lateral 2/3

in placing the pins, the pin should be ___ the equator.

below

how much torque should the adult pins be set at?

8 in/lbs

how much torque should the pediatric pins be set at?

2-4 in/lbs

what torque should the superstructure be set to?

30 in/lbs

what is the golden rule for applying pins in a pediatric Halo?

half the torque, double the pins

what is the concept of directed growth behind cranial helmets?

provide total contact in areas where growth to be curbed and allow space in areas where growth is desired

what indications the FDA define a CRO as the appropriate treatment?

3-18 months of age with moderate to severe nonsynostotic positional plagiocephaly

what is SIDS?

sudden infant death syndrome: infant deaths that cannot be explained

what is the back to sleep campaigns recommendations?

supine positioning, use of firm sleep surface, room sharing without bed-sharing, and avoidance of soft bedding and overheating

what are some risk factors for plagiocephaly?

multiple births, large fetus, first pregnancy, breech, early descent into pelvis, assisted delivery, extended periods supine, constraining devices, torticollis

what is torticollis?

tightness of sternocleidomastoid

what is plagiocephaly?

occipital flattening, ipsilateral anterior ear shift, forehead bossing, ipsilateral vertical increase vault height, temporal bossing

what is cranial vault asymmetry?

the absolute value of the difference of cranial diagonals, normal value is <4 mm difference

what is cranial vault asymmetry index?

CVAI: normal values <3.5

what is brachycephaly?

central occipital flattening, widening of posterior skull bilaterally, vertical increase in vault height and temporal bossing

what is the cephalic index?

the measured width of head divided by the length of the head multiplied by 100, 80-90 normal

what is asymmetric brachycephaly?

combination of plagio and brachycephaly

CVA>8 mm and CI > 94%

what is dolichocephaly?

increased cranial length, decreased cranial width, prominent posterior cranium, CI<78%, no ridging and no frontal bossing

what is craniosynostosis?

birth defect in which sutures close prematurely prior to birth

what is sagittal craniosynostosis?

increased cranial length, decreased cranial width, prominent posterior cranium, CI<70%, ridging along sagittal suture, frontal bossing, occipital bossing

what is unilateral coronal synotosis?

frontal flattening ipsilateral to fused suture, orbital rim heightened ipsilateral to synostosis, frontal bossing contralateral to fused suture, nasal deviation

what is metopic encephaly?

metopic ridging, triangular frontal bones, bitemporal narrowing, biparietal widening

what is unilateral lambdoid plagiocephaly?

posterior flattening ipsilateral to synostosis, posterior ear shift ipsilateral to synostosis, cranial vault height increase contralateral to synostosis, frontal bossing contralateral synostosis, mastoid bulge

what is the difference between lambdoid synostosis and plagiocephaly?

lambdoid: trapezoid, ear shifted posterior to posterior flattening, mastoid bulge, frontal bossing contralateral to posterior flattening

positional plagiocephaly: parallelogram, ear shifted anterior ipsilateral to posterior flattening, frontal bossing ipsilateral to posterior flattening

what are the surgical options for plagiocephaly?

endoscopic osteotomy/craniectomy/suturectomy: 2-5 months, remove the fused suture, minimally invasive, fast recovery, correction can slightly regress

cranial vault remodeling: >6 months, entire scalp reflected, more bone removal, faster/longer lasting correction

who diagnoses plagiocephaly or other cranial defects?

pediatrician/pcp

what are some common interventions before jumping to cranial remolding therapy?

repositioning, tummy time, PT

what are the cranial remolding therapy wear cycle?

wear for 23 hrs per day, wear for 3-5 months, helmet resists growth in areas of bossing and direct growth into flat areas

what are the contraindications for a CRO?

hydrocephalus with no shunt, craniosynostosis, infants older than 12 months of age

what is the anterior superior trimline for a custom TLSO?

12 mm inferior to sternal notch

what is the anterior inferior trimline for a custom TLSO?

12 mm superior to pubic symphysis, inferior to ASIS with adequate clearance for rectus femoris

what is the lateral superior trimline for a custom TLSO?

37 mm inferior to pectoralis tendon for adequate clearance

what is the lateral inferior trimline for a custom TLSO?

12 mm proximal to the greater trochanter

what is the posterior superior trimline for a custom TLSO?

12 mm inferior to lowest point of spine of scapula

what is the posterior inferior trimline for a custom TLSO?

at sacrococcygeal junction

what is the anterior superior trimline for a custom LSO?

12 mm inferior to xiphoid process, incorporate inferior costal margin

what is the anterior inferior trimline for a custom LSO?

12 mm superior to pubic symphysis, inferior to ASIS with adequate clearance for rectus femoris

what is the posterior superior trimline for a custom LSO?

12 mm inferior to angle of scapula

what is the posterior inferior trimline for a custom LSO?

at sacrococcygeal junction

what is the lateral inferior trimline for a custom LSO?

12 mm proximal to trochanter

what is spondylosis?

bony overgrowths at vertebral bodies associated with aging

what is spondylolysis?

defect or fracture of pars interarticularis, common in sports

what is spondylolisthesis?

anterior displacement of vertebral bodies following bilateral spondylolysis