Spica casting

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.

Complications

Loss of reduction
Compartment syndrome
Pressure sore

Pitfall: compartment syndrome

Take care not to use excessive force during the casting procedure. Avoid putting too much pressure on the cast while holding the reduction.
It is also important to avoid flexion of the hip and knee beyond 90° as extremes of flexion are associated with an increased risk of compartment syndrome.

Material

Tubular bandage (stockinette) sized both for leg and for body
Cast padding
Felt
Casting material: fiberglass or plaster of Paris

Equipment

Hip spica box or table
Folded towel as abdominal spacer

Read the additional material on preoperative 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.

Placement on hip spica box

Transfer the anesthetized child onto the hip spica box. 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.

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 the nipple line, or just below, 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.

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.

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

Finalizing the cast

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

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.

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.

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.