The effect of pin location on the rigidity of the halo pin-bone interface

Optimal insertion of halo fixation pins to maximize the rigidity of the interface between the halo pins and the outer table of the skull is important in reducing the incidence of pin loosening. An in vitro biomechanical study was performed using cadaver skulls to investigate the effects of pin location on the rigidity of this pin-bone interface. Halo pins were inserted at nine positions within a recommended "safe zone" for pin insertion. It was found that the rigidity of the pin-bone interface progressively decreased as pins were inserted more superiorly on the calvaria. The rigidity of the interface did not change significantly when the location of the pins was varied in the horizontal axis. This reduction in interface rigidity associated with inserting pins more superiorly on the skull may be related to an increase in the angle of insertion of the pins with respect to the surface of the calvaria. Based on this study, a change in the technique of halo pin insertion is recommended. Pins should be placed as inferiorly as possible, close to the supraorbital ridge, to achieve the most perpendicular angle of insertion and thus the most rigid fixation. The improved rigidity obtained with perpendicular pin insertion may minimize the rate of pin loosening and other complications associated with use of the halo orthosis.