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Hip Spica Cast

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Other Names

Illustration of patient positioning on the spica box[1]
Hip spica cast with abdominal window[2]
Bilateral long leg and one and a half hip spica cast illustrations[3]
A nearly completed one and a half hip spica. Note the perineal window has been cut but not removed[4]
  • Unilateral Hip Spica Cast
  • Bilateral Hip Spica Cast
  • One and a Half Hip Spica Cast
  • Short Leg Hip Spica Cast
  • Single Hip Spica
  • Double Hip Spica
  • Pantaloon Casts
  • Two Leg Hip Spica
  • Single-Leg Spica Cast
  • Abduction A Frame Cast

Background

  • This page refers to hip spica casts, a cast type typically used in children
    • Generally speaking, the cast involves the trunk and one or both legs
    • Extent of coverage depends on the pathology and the surgeon
  • Truncal component
    • Depends on pathology and surgeon
    • Can extend to naval, allowing mobility of the spine
    • Can extend to rib cage or even axilla

Types of Hip Spica Casts

  • Single: Covers one leg to the ankle or foot
    • Sufficient in most circumstances
  • Double: Covers both legs
    • Surgeon preference, can provide more stability to the cast
  • One and a Half: Covers one leg to the foot or ankle, the other to above the knee

Indications


Contraindications

  • Unacceptable shortening or angulation
  • Open fractures
  • Thoracic or intra-abdominal trauma
  • Large or obese children
  • Inability for parents to care for child

Procedure

Equipment

  • See: Casting materials
  • Extra material for this cast
    • Folded towel as an abdominal spacer
    • Hip spica box or table
    • Back Support

Technique

  • Stockinette
    • Use generous tubular bandage on the torso and injured leg
    • Sew the two parts together to prevent separation of the bandages if the child is moved
    • A back support is placed inside the tubular bandage, directly against the child's skin
  • Hip Spica Box
    • Place the anesthetized patient on the hip spica box
    • Placement on the back support should leave the torso exposed for casting
  • Leg Positioning
    • Hip Flexion 45°, hip abduction 30°, knee flexion 70°
    • This position allows for comfort while sitting
    • Place a folded towel over the central abdomen inside the tubular bandage
    • This creates space int he cast for breathing
    • The tail of the towel should be exposed towards the neck for ease of removal
  • Cast Padding
    • Apply a layer of cast padding
    • Use a larger width for the body and a narrower one for the legs
    • Extend from the nipple line to just above the malleolus
    • Optional: apply felt padding over the edges of where the cast will be
  • Cast Material
    • Apply the first layer of cast material, taking care to connect the leg and body securely
    • Apply reinforcement slabs of cast material between the body and leg segment
    • Fold the stockinette and padding over the edges before applying the final layer of cast material
  • Place the child back on the examination table
  • Remove the back support and abdominal towel
  • Trim edges of the cast as needed to allow free movement of the opposite hip, access to perineum

Pearls and Pitfalls

  • For the thoracic component, consider abdominal window
    • Consider a window in the abdominal portion of the cast
    • Allows for greater comfort while breathing and eating
    • Especially important for older children
  • Optional: use waterproof adhesive tape to the perineal edge of the cast
  • Consider Gore-Tex soft wrap instead of cotton since it can be cleaned if it gets wet or soiled

Aftercare

  • Typically non-weight bearing until re-evaluated
  • Advise patient to keep cast or splint clean and dry
  • Do not insert objects into splint/ cast
  • Monitor for complications (worsening pain, paresthesia/ numbness, color changes)
  • Seek further care if unable to control pain at home

Additional Cast Care

  • Goretex liner allows the child and the cast to be washed;
  • Panty shield napkin can be applied to the perineum to prevent soiling of the cast;
  • Child is seen every 2 weeks for evidence of skin break down

Complications

  • Acute Compartment syndrome
    • The ability to passively/actively extend fingers without discomfort indicates absence of muscle compartment compression
  • Plaster burn/ thermal injury
  • Pressure sores
  • Nerve palsy
  • Vascular compromise
  • Splint dermatitis
  • Permanent joint stiffness
  • Skin infection
  • Respiratory Distress
    • The patient may develop respiratory symptoms if the thoracic component is too tight
    • It can be split down the side(s) similar to a bivalve and spread to allow for expansion
    • Alternatively, it can be removed and re-applied

See Also


References

  1. Image courtesy of https://surgeryreference.aofoundation.org/, "Hip Spica"
  2. Image courtesy of https://www.wheelessonline.com/, "Hip Spica Cast"
  3. Image courtesy of uvmhealth.org
  4. Image courtesy of vumedi.com
Created by:
John Kiel on 3 August 2023 13:27:27
Authors:
Last edited:
21 August 2023 04:11:13
Category: