Hip spica casts

A hip spica is a cast (the same type of plaster we use to splint broken bones) which extends from the abdomen and down both legs. How far down the leg it comes depends on the reason for the cast.

Some spicas have a cross bar between the legs which adds stability to casts in older children. You will be taught how to lift and carry your child before discharge.

Nappy and hygiene care

Regular nappy checks every 2 to 3 hours in the day will help prevent soiling and wetting of the cast. This then prevents nappy rashes or sores and the cast becoming soft. This is important as replacing a ruined spica often requires another anaesthetic and visit to theatre.

To prevent the skin getting sore, a smaller nappy is placed inside the cast by tucking it slightly inside the opening of the cast between the child’s legs. Bed pans and urinals can be used for older children.

Each child will be seen and assessed on the ward by the occupational therapist. The use of barrier creams around the nappy area is recommended. If the nappy area becomes red and sore it may be advisable to see your GP for a prescribed cream. Waterproof tape ‘sleek’ is placed around the edges of the spica in the nappy area. This will need to be replaced when needed. Nursing staff will show you how to re-apply it.

Changing position and holding your child

A child in a spica can be lifted with one arm supporting the legs and the arm supporting the child’s back. The cross bar should not be used when lifting as it may break.

You will be able to continue having cuddles in this position. When positioning your child to relieve pressure areas, always ensure that they are turned and rested on the opposite side of the affected hip, after that support position with pillows. Alternatively, if both hips have had surgery, relieve by wedging a pillow slightly under spica.

Your child can be positioned on their back or sides for short period throughout the day. Make sure all extremities are well supported.

Feeding

Younger children are less likely to be affected by the hip spica although ‘wind’ and colic can be troublesome. Winding after feeding is important.

The hip spica cast may cause eating and drinking to be awkward, and your child may experience some discomfort. Most children are happier with smaller meals or snacks as they soon feel full due to the cast around their tummies. Constipation can be a problem, so give plenty of fibre, fruit and vegetables, and ensure they have plenty of drinks.

Feeding your child in a hip spica offers problems mainly due to positioning. A small child can be fed on their backs with pillows to elevate the head and support their legs. Bean bags can also be used. You can also cuddle your child in your arms for feeding and breastfeeding. Older children can be positioned in an upright position on your lap with their legs either side of your legs.

Sleeping

Children may only sleep for short periods and become restless and distressed. This could be due to cramps, spasms or itching and the inability to turn over.

It may take some practice to find a comfortable position. Pillows or rolled up towels can be used for support, but take care to prevent pressure points or strain on the cast.

You must check nappies more frequently, at least twice in the night. At the same time check pressure areas and change position if required. Your child may require fewer blankets because the plaster will act as insulation.

Play activities

Play activities should be encouraged, very active play will be difficult therefore your child may rely on more craft activities and imaginative play. It is most important to involve them as much as you can with their peers so they do not feel isolated. Using a bean bag to prop your child up can make play on the floor easier.

Removal of hip spica

Hip spicas are removed in hospital with the use of a plaster saw. This procedure is noisy and may feel uncomfortable. You should give some pain relief at home before coming for the removal to ease any discomfort.

Some patients with poor bone density or cerebral palsy are at a higher risk of re-fracturing (break of bone). If you are concerned about your child once their cast has been removed, please speak to the nurse or doctor in clinic.

After removal of the hip spica your child may need to have an X-ray. Again this can cause some discomfort due to positioning and your child may appear stiff. This gradually resolves. Warm baths are good to gently help your child start moving their legs again.

Your child’s skin may look flaky and dry, this can soon be resolved by applying a good moisturising cream regularly.

Travelling by car

If your child is unable to travel in their normal car seat due to the hip spica then you must let the doctors know prior to discharge. There are now exemption certificates on the ward for parents and carers to have which will be filled in by the doctor on discharge, which allows your child to travel in the car legally.