In this section
Definition of Terms
Discharge Planning and Assessment
Family Centered Care
A hip spica is a plaster cast that extends from the torso down to the feet and is applied in theatre under general anaesthetic. The objective of the hip spica is to immobilise the hip, pelvis and/or femur to correct and maintain hip deformities. A spica cast can be used for stabilisation of pelvic or femur fractures, or post reduction/reconstruction for developmental dysplasia of the hip (DDH). Children having a closed/open reduction to correct hip dysplasia may have the cast on for 12 weeks, with a change of plaster occurring after 6 weeks. Before surgery, some children may be placed in traction, which is aimed at decreasing muscular contractions, to increase the chances of a successful closed reduction in DDH, or to stabilize and promote realignment of a fracture. Hip spicas are generally used for children from 6 months to 6 years of age. The nurse plays a pivotal role in the acute post-operative management and in the education and support for families. Postoperative care involves pain management, assessment of neurovascular status, hygiene and nutrition needs. One of the most challenging aspects of caring for an incontinent child in a hip spica is keeping the cast clean and dry and maintaining healthy skin integrity. Nurses have an important role in preparing parents for discharge. The hip spica can stay in situ for 6 weeks to 6 months, depending on the medical condition. Caring for the child in a hip spica at home can be very stressful, therefore it is essential that nurses provide the appropriate support and discharge education.
Bivalve: Splitting the plaster cast in two complete pieces to relieve swelling, pressure or neurovascular compromise, or to allow for frequent assessment
Closed reduction: The hip is gently manipulated into the acetabulum by flexion, traction and abduction under a general anaesthetic and then immobilised in a hip spica cast. An adductor tenotomy, which involves percutaneous lengthening of tendons, may also be performed.
Developmental Dysplasia of the Hip (DDH): An abnormality in the development
of the hip joint. The size, shape, orientation, or organisation of the femoral
head, acetabulum or both can be affected. The abnormality may be congenital or
may develop during infancy or childhood.
Femoral/Pelvic osteotomies: Usually performed on children with DDH greater than 18 months. The cutting and repositioning of bone required to reconstruct and safely maintain the hip in the reduced position.
Hip Spica: A plaster of Paris covering the torso and continuing down to the ankle on the affected side and to the knee on the unaffected side or covering bilateral legs to the ankle. There is an opening around the perineal area for toileting. Used to immobilise and maintain optimal position for abduction and flexion of the hips, pelvis, and/or femur.
Open Reduction: Usually performed after failed closed reduction in children greater than 2 years. Involves lengthening tendons, removing obstacles to reduction and tightening the hip capsule.
It is preferable not to
apply sleek to the top of the hip spica around the abdomen due to risk of
causing sweating and rashes. Orthopaedic felt can be used to cushion the area,
and is usually in situ post-operatively.
Figure 1. Applying waterproof tape to edges of the perineal area
Figure 2. Applying waterproof tape to edges of perineal area and scotching the plaster.
Mesenteric artery syndrome/cast syndrome can occur isas a rare complication secondary to pressure of the cast around the abdomen. It is associated with proximal duodenal obstruction resulting in the external compression of the third portion of the duodenum by the superior mesenteric artery. Signs and symptoms are general and unpredictable in nature and can include emesis which is frequently bilious, and may contain partially digested food, nausea, early satiety, and abdominal pain. Diagnosis occurs by performing upper gastrointestinal imagingseries withusing contrast. Constant monitoring of the cast is essential.
Parents and carers need to be aware of this complication before the child is discharged from hospital. If, after the child is at home, the cast is found to be too tight around the abdomen, the child needs to attend their closest hospital emergency department as soon as possible. A small round hole can be cut into the cast to relieve the pressure on the child’s stomach.
Figure 3: padding used for infant in car seat.
It is neither legal nor safe for parents to use the following information to make changes to their child's restraint without the advice of a trained health care professional. In Victoria, it is compulsory for children travelling in a vehicle to be restrained appropriately for their age and height, with a child restraint that complies with the Australian/NZ Standard 1754. Please see the vicroads website for current information vicroads-child restraintsSee also Product Safety Australia- Child restraints for use in motor vehicles
If the patient is unable to be fitted into an appropriate restraint they must be transferred home via non-emergency patient transport and follow up transfer for outpatient appointments to be organised by the patient’s GP.
If using EMR, there are two letters available in the Communication Management Activity. Both letters need to be completed and provided to the parent/carer before the patient is discharged. The RCH Medical Car Seat Letter is to be accessed, printed and signed by the medical team. The OT car seat letter is to be completed by the OT or nurse fitting the car seat as well as the parent/carer. Follow this process to complete both the RCH Medical Car Seat Letter and the OT car seat letter
Once completed, print by clicking preview and print.
Further information can be located on the TOCAN website http://www.rch.org.au/tocan/ Car seating guidelines are specific to the Royal Children’s Hospital, Melbourne
The child in a hip spica needs to be assessed to determine if they fit into their pram. Please refer to physiotherapy for fitting of all prams/strollers and wheelchairs. If the child does not fit into their own pram, an alternative pram can be fitted by physiotherapy and then hired from EDC. Older children may require a reclining wheelchair which can also be hired from EDC.
Refer to TOCAN Case Studies for examples of troubleshooting car-seating and restraints for individual medical conditions http://www.rch.org.au/tocan/case_studies/Case_Studies/
Please click here to view the evidence table.
Please remember to read the disclaimer.
The revision of this nursing guideline was coordinated by Kiralee Ciampa, RN, Platypus Ward,
and approved by the Nursing Clinical Effectiveness Committee. Updated February 2018.