Authors of section

Authors

Arnold Besselaar, Daniel Green, Andrew Howard

Executive Editor

James Hunter

General Editor

Fergal Monsell

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Hip spica casting

1. General considerations

Single-leg, one-and-a-half-leg, or two-leg spica

Whilst a single-leg spica is adequate for most circumstances; some surgeons prefer to extend the cast to the uninjured side as this can help to provide more stability, especially in young children.

Single-leg and two-leg spica

Complications

  • Loss of reduction
  • Compartment syndrome
  • Pressure sore

2. Patient preparation

Dressing

Cut a generous length of tubular bandage to dress the injured leg and a larger diameter tube for the torso. Tape the two parts of the tubular bandage together to prevent separation of the bandages as the child is moved.

Place the back support for the spica box against the patient's skin underneath the tubular bandage.

Application of dressing

Placement on hip spica box

Transfer the anesthetized child onto the hip spica box or table. Make sure that enough people are available to help positioning and stability.

The child’s sacrum should rest on the back support with its perineum against the padded post. The shoulders should be supported by the spica box leaving almost the entire torso free for casting.

The back support can be secured to the apparatus with tape.

Pitfall: Avoid inadvertent extubation during transfer and casting. Discuss airway management with the anesthetist beforehand.
Placement of patient of hip spica box

3. Single-leg spica

Dressing

Place a folded towel over the central abdomen, inside the tubular bandage, to create space in the cast for breathing. Bring the tail of the towel towards the neck for ease of removal.

Creating space in the cast for breathing

Padding

Apply a layer of cast padding, using a larger width for the body and a narrower one for the leg.

The cast extends from between the nipple line and umbilicus to just above the malleolus of the ipsilateral ankle.

Consider adding thick felt over the padding at the free edges of the chest and leg.

Application of padding

Cast application

Apply a first layer of cast material to the leg and body sections, taking care to connect leg to body securely, in a figure of eight (spica technique).

Pitfall: While not common, compartment syndrome may occur after application of a spica cast. The cast should therefore end above the ankle to allow evaluation of pulses and foot and ankle movement.
Application of first cast layer

Reinforcing slabs of casting material may be applied between the body and leg segments.

Application of reinforcing slabs

Molding to maintain reduction

While the cast is still soft, create a supracondylar mold and a varus or valgus mold to counter the potential direction of displacement, determined by the configuration and level of the fracture.

Gently mold the cast to the curve of the tibia and around the knee.

Pressure should be continued until the cast hardens.

Molding the thigh segment to maintain fracture reduction

Finalizing the cast

Fold the tubular bandage and padding over the edges before applying the final layer of casting material.

Application of final cast layer

Once the cast material is hardened transfer the child from the spica box and remove the abdominal towel and the back support from the cast.

Trim the edges of the cast, to allow flexion of the opposite hip and adequate access to the perineal area.

Consider adding waterproof adhesive tape to the perineal edge of the cast.

Adjusting the hardened cast

Splitting the cast

If the cast around the abdomen has been applied too tightly, split it down the side and spread to allow for expansion or remove and reapply it.

Splitting the cast

4. One-and-a-half- and two-leg spica

One-and-a-half- and two-leg spicas are applied in the same way as the single-leg spica with the cast, on the contralateral leg, extended to the knee or ankle.

Apply reinforcing slabs of casting material across the hip region of both legs.

One-and-a-half-leg and two-leg spica

Option: bar

Consider the addition of a bar between the two legs to provide more stability to the cast.

Addition of a bar between the legs