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Plymouth Paediatric Orthopaedics

You and Your child in a Hip Spica

A Hip spica is like a plaster pair of shorts. It acts to hold the hips still for a variety of conditions. They sometimes come down to the ankle and sometimes to above the knee and allow knee movement. They come up to just above the bottom of the rib cage. A gap is left between the legs for nappies and toileting.

During surgery

Any wounds are covered with a plan to leave the dressing untouched for the period of casting. This may include the dressing covering the epidural site (the anaesthetic injection site in the back if your child has this)
It is well padded. There is always space left for the tummy to expand after eating although it may look slightly tight around the chest.
The positioning of the legs is for the best position of the hip and not always the easiest position to look after.

After surgery

The edges of the cast are padded and tapped – to stop rough edges rubbing and make at least the edges wipe clean.
We will show you how a nappy inside and another over works best. (One nappy the size you normally use and one bigger – usually the biggest you can find for over, in children over 3 years the nappy can be extended at tapes to fit)
We will show you how to check for circulation problems, bleeding or rubbing of the cast before you leave.
We will check you are happy caring for your child and give advice on car seats and pushchairs.
There is access to a small amount of equipment through our parents group at www. Facebook.com (families coping with hip dysfunction dysplasia).

Going home

Babies often fit in the normal car seat. However you may need to borrow a bigger seat from an older family member or friend. In much older children the hospital may have to transport them home.
The law states :In a private vehicle a child must be in a seat. In a taxi without car seat available they can be unrestrained in the rear if under 3 yrs. This allows transport in taxi for all under 3yrs. All children over 3 yrs should have a discharge plan in place before surgery.(this will be done or put into action at the pre assessment visit or phonecall
At home bean bags are invaluable. A few cushions in the pram. A cycle cape often helps with the great British weather, or a simple piece of nylon with a hole cut for the head.
Every Hip Spica will smell by the time they come off. Changing nappies more frequently can help.

 Hip Spica Removal

This will happen at Derriford Hospital with your child awake. It can cause a short period of distress as the device used to remove the plaster is noisy. It cannot hurt your child. They generally settle very quickly. It is much safer than using another anaesthetic.
Then your child will have an xray for documentation. We use this to compare to the next xray taken when you come to clinic. This later appointment is when it will be used. It does not need review on the day.
Then we give you time to get used to your child being out of cast on the ward. Babies are back to normal very quickly, older children take longer as they need to get back to more movement to allow walking. The physiotherapists on the ward will work with you and decide when you’re ready to go home. This may be the same day (babies) or involve a few nights stay. You should bring a swimsuit in case hydrotherapy is needed.

Going home again

The hip will gradually regain its movement and your child will return to lying, crawling, or walking as before. It can take several weeks for this to happen. The joint is stiff and can be uncomfortable but also the child may be anxious and take time to trust the movement again. The surgeon would usually see you in clinic at 3 months after this although this can vary.


Physio for general problems 01752 517756

Plaster room for cast problems 01752 517508

If your child is unwell then the GP is the first port of call and can be seen at Derriford by the Paediatric orthopaedic team or on call team if needed.


Preassesment Plan of a child in Hip Spica

In addition to routine Plym preassessment the following should be completed for any child that may go into a hips spica or broomstick casts

Transport why and how

  1. Inform parents that final decision re cast will be on the day of surgery eg size, above/below knee etc.
  2. Plan for transport is there responsibility with our help
  3. Under 3 yrs options are – may fit in own car seat/ borrow larger seat from family/friend/parents group/ buy a larger seat. Get a taxi home and hold the child in the back.
  4. Over 3 yrs we need a clear plan of discharge and paediatric OT should confirm this is done. Options are may fit in own car seat/ borrow larger seat from family/friend/parents group/ buy a larger seat. We do not have the taxi option here. So if nothing can be arranged hospital ie ambulance transport is only option.
  5. Patients and families will then need a follow up phone call to ensure transport arrangements are made. If not then plan to book taxi if <3 yrs and admit to hospital and get hospital transport if > 3 yrs old.
  6. Document plan in green book please

Other things

Show parents the spica demonstration doll or pictures to explain it. If this is not available or doing preassessment by telephone then refer to website as lots of pictures!

Refer to STEPS website for more information. (Plaster advice applicable to all but is obviously specific to congenital hip dysplasia in other areas.)