A hip spica cast is normally needed following surgery or when an injury involves either a fractured femur or an injury to one or both of the hip joints. It is defined as an area covering the trunk of the body and either one or both upper legs. Its purpose is to immobilize the hip joint, pelvic bone, and/or femur until the injury or surgical procedure has had a chance to heal. In most cases – where only one of the joints or one side of the hip has been injured or operated on – a single cast will be used. If it is necessary to place both legs in the cast (a less common situation), a double spica will usually be used.
When It Is Not Necessary
Not all injuries or surgeries require the use of a cast, nor do many disorders such as hip dislocations or the occasional hip abnormalities experienced by infants. Very often, a hip spica wrap or brace will serve the purpose and is all that is needed. Athletes who have injured a muscle or tendon in the hip area tend to favor a hip spica wrap as sufficient to allow the injured muscle or tendon time to heal. A wrap can be a better choice in cases where it isn’t necessary to totally immobilize the hip.
When It Is Necessary
When a cast is called for, the actual configuration of that cast can vary considerably. Depending upon the severity of the problem, it may extend as far down as the top of the knee and as far up as the armpit. The latter configuration may be required if it is necessary to immobilize the lumbar portion of the spine in addition to immobilizing the hip. It is most often referred to as a body cast.
A cast is most often placed on infants following surgery for hip dysplasia, a developmental condition where the hip joint can easily be dislocated. This is usually a result of the joint not having been formed correctly before birth. In some cases, the problem will not become apparent until sometime during the first year following birth.
There are three general categories of hip dysplasia. The most severe case is when it is dislocated, which is to say the head of the thigh bone or femur is completely out of the socket and remains there. A less severe case is that of the hip joint being dislocatable rather than actually dislocated. This is a more common situation, and is a condition in which the joint is positioned normally but can become dislocated whenever light to moderate pressure is applied. More common still is where the hip is subluxable. This is a condition in which the femur is not held as firmly in the socket as it should be, but it is unlikely to become dislocated.
In less severe cases, the use of a cast is generally not called for. A brace or a simple harness may suffice. A harness or brace may need to be worn for several months until the hip has had a chance to develop fully and correctly. Surgery is usually not required for infants unless the femur will not fit properly into the socket. As a child grows older and becomes more active, the need for a surgical procedure may become apparent if the condition worsens. In most cases, the purpose of a surgical procedure is to restore the hip to its normal anatomy.
When an infant is required to wear a spica cast, there are usually several challenges. One of them is to keep it clean, which can become more difficult as the child grows and becomes more active. Special precautions often need to be taken to protect the child’s skin from irritation. Small children tend to examine it, play with it, and try to stick small items inside it. It also needs to be kept dry. Parents often have to resort to giving their children sponge baths. Going to the bathroom can pose a problem as well, as the child will sometimes need to assume an awkward or unnatural position to avoid soiling the cast. This is something an infant or a toddler won’t always easily do.
One item sometimes overlooked at the time a cast is put on is clothing. This is particularly true when placed on the legs or ankles. All of a sudden it becomes impossible to wear trousers without splitting them up the side. A spica cast creates more of a problem, since regular clothing may no longer fit. Most infants don’t need to wear trousers, but the cast must still be taken into account when deciding what can and cannot be worn. A large T-shirt for a boy or a loose dress for a young girl may often be all that is necessary. In some cases, special clothing can be designed in the home by cutting seams and installing Velcro straps or patches. There are times when practicality is more important than style, and the need for Velcro is often one of those times. For the very little ones, a bib or towel at feeding time can come in handy to prevent food from falling down inside the front of the cast.
Another thing that can be overlooked, particularly when an infant or toddler is involved, is the child’s car seat. A child may or may not fit into a standard car seat while wearing the cast. Some seats are adjustable and others are not. This is something worth discussing with the doctor before it is put on. It’s a good idea to bring a car seat with you to the doctor’s office or hospital. The surgeon or physician may be able to configure the cast to fit into the seat.
Wearing a cast is not fun for anyone, and a young child may think wearing it over his or her hips is the worst thing in the world. It is not the worst thing in the world, but for parent and child alike it can be quite stressful.