Hip Spica

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What Is A Hip Spica?

A hip spica is a lightweight plaster cast; it covers one leg down to the knee and other treated leg down to the toes and up to the belly button level.There will be an open area around the groin area to
allow for toileting. These types of plasters are used for children after hip surgeries and those with fractured femurs to prevent movement of the bone.

What about toileting?
There will be a ‘letterbox’ opening for hygiene in the plaster. We advise you to use two nappies with a smaller one inside and a larger one over the cast. A sanitary pad or pleat of cotton wool inside the first nappy will increase the absorbency and minimise the risk of leaks out the back. You will need to experiment and find out what works best for your child. It is important that the skin stays as clean and dry as possible. We therefore recommend that initially you check your child’s nappy on a regular basis, such as every couple of hours to ensure they remain dry.

How should I look after my child’s skin?
• Skin around the edges of the plaster should be checked every day for redness, blisters, pressure areas or skin irritations.
• Your child will continue to grow with a hip spica on, so check regularly to make sure the plaster is not too tight.
• Powders and creams should only be used on skin that you can see as under the plaster this can cause skin irritations.
• Be sure that your child does not poke things down the plaster as they can cause skin grazes and may also become stuck.

Unfortunately, while your child is in plaster they will not be able to have a bath. You will need to give them a strip wash – ensuring the plaster does not get wet. If your child is small enough he can be laid on towels on the draining board of the kitchen sink to have a hair wash over the sink or on the floor on your lap with a washing up bowl and plenty of towels.

Velcro can be used on legs of clothing to ease in dressing.

Avoid any fruit juices or foods which cause loose stools or diarrhoea. Decrease amount of fluids in evenings before bedtime.

How should I position my child?
• Children in a hip spica cannot move easily, so you will need to change their position often. Position changes are necessary to avoid getting sores under the plaster. Every time you change the position, check that the plaster is not digging in or too tight around the edges (tummy, ankles, groin and knees). This also includes when placing them in the car.
• Make sure your child’s heels/feet can be moved freely after each position change. Ensure their feet are not pressed into the mattress/chair, which could cause pressure.
• If your child develops a reddened area on his or her back at the spine, he or she may need to spend more time on their stomach.

How should I lift my child?
• When lifting or picking your child up, it is important to support them as well as the weight of the plaster. Do not lift them under the arms without supporting the plaster as well.
• Keep your child as close as possible to your own body when picking them up and bend your knees. This helps prevent straining your back and ensures your child feels secure.
• A small child can be cuddled in the same way as before they went into plaster without fear of hurting them.
• Older children in hip spicas can be very heavy and you may need two people to prevent you injuring your back

Special Equipment
If you feel that your child would benefit from specialist equipment please contact occupational therapy who may be able to carry out assessment prior to your child being discharged home from ward 5.

Legal responsibility to use the correct child restraint in respect of children to the age of 14 years travelling in motor vehicles lies with the driver of the vehicle. This responsibility includes ensuring the safe transport of your child whilst in a hip spica. The hospital cannot provide children’s car seats or other forms of restraint for use in motor vehicles. Often smaller children in plaster will be able to sit in their own car seats by lengthening the shoulder and groin straps. Small children in full or one and a half hip spica casts may be able to straddle across a booster seat or a car seat with low sides, if they are of an appropriate age/weight.

You need to carefully consider where in the car your child is to be seated, whether in the front passenger seat or in the back. The depth of the seat and leg space has to be measured to ensure there is enough space. You also need to check where you are allowed to place your child in your car, for example if you have front air bags you are not allowed to place your child in the front passenger seat. Advice and information, including current legislation regarding the safe transport of children, is available through RoSPA (Royal Society for the Prevention of Accidents). Tel: 01212 482 000 or www.rospa.com

A car seat designed specifically for children with hip spicas is available to buy or hire from the In Car Safety Centre. Tel: 01908 220 909.

If your child is too big to utilise the above options or you do not have a car he/she will need to be transported in an ambulance to and from hospital whilst in a hip spica. This will be arranged by the ward when travelling home from hospital only. Paediatric community nurses will contact you once you have been discharged from the ward. They are available to offer you advice and
support throughout the time your child is in plaster.

Contact Telephone Numbers:
• Paediatric Community Nurses
• Telephone No: 01908 660033 Ext 2703
• Ward 5: 01908 243051
• PAU Ward 4: 01908 660033 Ext3196
• Plaster room: 01908 995185
• Equipment loans services MK 379450
• Occupational therapy (CDC) 01908 660033 ext 3908

References for this information leaflet can be obtained from the author should they be required.