Hip Spica Cast

- See: Pediatric Femoral Frx Menu

- Discussion:
    - timing:
           - Immediate single-leg spica cast for pediatric femoral diaphysis fractures.
    - contraindications:
           - unacceptable shortening or angulation;
           - open fractures;
           - thoracic or intra-abdominal trauma;
           - large or obese children (inability for parents to care for child);
    - position of spica:
           - place affected thigh in 10 deg of abduction or in neutral position w/ opposite hip in moderate abduction to facilitate perineal hygiene;
           - to decrease muscle forces & to minimize amount of shortening, place the lower extremity in the relaxed position;
                   - w/ hip flexion, abduction, external rotation & knee flexion;
                   - common mistake is to place the fractured thigh in marked abduction w/ resulting lateral bowing due to the pull of strong adductors;
                   - consider placing the limb in the correct position before application of spica;
           - proximal 1/3 frx:
                   - hip flexion   :     45 deg
                   - hip abduction:   30 deg
                   - ext rotation:      20 deg
           - mid shaft fractures:
                   - hip flexion:        30 deg
                   - hip abduction:   20 deg
                   - ext rotation:      15 deg
           - distal 1/3 frx:
                   - hip flexion:        20 deg
                   - hip abduction:   20 deg
                   - ext rotation:      15 deg

- Technique:
    - technique pearls: padding:
           - place a folded towel on the anterior thorax and abdomen and apply all padding and casting material over this towel;
                   - following cast application the towel is removed;
                   - this will create space between the cast and the thorax/abdomen and will avoid cast tightness and difficult w/ breathing;
                   - using this technique, it is not necessary to window the abdomen of the cast;
           - its useful to place 2 layers of body stockingette over the patient's torso to ensure that the cast padding can be pulled up over the edges of the cast;
           - gortex soft wrap is preferable to cotton wrap (gortex can be cleaned if it gets soiled);
           - soft wrap (preferably Gortex) is placed, w/ care to evenly spread the cotton across the back and buttochs (including sacrum);
           - a thick belt of felt is taped across the chest, just below the nipple line;
           - a second felt belt is fashioned to cover the sacrum, PSIS, and ASIS;
    - reduction:
           - prior to cast application, use flouro to help determine the optimal position for reduction;
           - distal femoral traction pin is inserted if fracture needs to be brought out to length;
           - apply the cast, but apply minimal cast material around the injured thigh;
           - once the cast is hard, bring in flouro and determine if the reduction is adequate;
           - if the reduction is not adequate, then circumferentially cut the cast at the level of the frx;
           - then re-reduce the fracture under flouroscopic control;
           - once the reduction is adequate, have an assistant quickly apply more casting material while the thigh is held in the reduced position;
    - cast re-enforcement:
           - apply a "broom stick" between the thighs and apply cast material over this, inorder to strengthen the cast and prevent cast breakdown at the hip joint;        

- Cast Care:
    - goretex liner allows the child and the cast to be washed;
    - a 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

Improved treatment of femoral shaft fractures in children. The "pontoon" 90-90 spica cast.

Long-term results in the treatment of femoral-shaft fractures in young children by immediate spica immobilization.

Spica Casting for Pediatric Femoral Fractures: A Prospective, Randomized Controlled Study of Single-Leg Versus Double-Leg Spica Casts.

Immediate spica cast system for femoral shaft fractures in infants and children.

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Tuesday, June 19, 2012 2:20 pm