Question
My husband (on May 1) fractured C2 in a fall from a bucket loader on a tractor from 15 feet. He was flown by life flight to Sioux Falls and was fitted with a halo vest. He had extreme pain which worsened to a degree it was not manageable with pain medications.Last Tuesday, after x-rays, it was determined things were stable enough to remove the halo .The post on the one side was loose enough that the surgeon could not tighten it and hit any resistance. Now he has a collar, the post holes in his forehead are healing quite well; the ones behind his ears remain red and oozing with large scabs forming. I wash the area several times a day with peroxide. I am worried about the healing, is there anything else we should be looking for? He is not running any fever so not sure there is infection. Both back holes are still quite painful. He feels like a bobble-head but we expect weakness, I was encouraged to read your answer yesterday to the young man that was injured on the trampoline.So far walking has been the best exercise for him. Bending over is not good and generates pain very quickly. This has been a scary injury.

Answer
Dear Patricia,

If the halo has just come off, you need to give it some time.  He is still in a fragile state due to the fact that the musculature has not been activated for weeks. He will need to make sure that he does not do anything too strenuous until he gets some of the muscular strength back in the neck, and he should be in an active rehab program immediately to help regain active range of motion, and muscular control over movement.

The holes from where the halo was screwed to the skull will heal...just keep them clean like you are doing.  The covering of the skull and all bones is called the periosteum and is highly sensitive, so the bone will be very tender in this area for probably 4-6 weeks even after the soft tissue has healed over.

The bending over creates an increase in the inter-cranial pressure of the head due to gravity and also increase the local blood flow.  This will also take time.  Along with the walking, I would suggest that you have him start some lite swimming in the next 2-3 weeks as the halo holes heal up.  Being in the water will allow him some support while also allowing for free range of motion.  I am not talking about doing laps here..rather exercise such as floating on his back and moving his head to the sides, going underwater and creating head motions in all directions etc...  This will help create strength as the water will provide gentle resistance.  He should then be able to progress onward with more strenuous exercises.

Make sure he is in physical therapy...this is key for him.  I wish you both the best of luck in his recovery.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net