Hip Spica Cast

Other Names

Illustration of patient positioning on the spica box

Hip spica cast with abdominal window

Bilateral long leg and one and a half hip spica cast illustrations

A nearly completed one and a half hip spica. Note the perineal window has been cut but not removed

• 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

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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

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Indications

• Developmental Dysplasia of the Hip
• Femoral Shaft Fractures
  • In young children between 6 months and 5 years
• Stabilization of acetabular or proximal femoral osteotomies

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Contraindications

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

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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

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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

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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
  • Cellulitis from underlying wound, pressure ulcers
• 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

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See Also

• Casting Main
• Procedures Main

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