A spica cast is a specialized orthopedic device used primarily in infants and young children to immobilize the hip and leg joints. This casting maintains a specific anatomical position, allowing bones and soft tissues to heal correctly following injury or surgery. Because the cast covers a significant portion of the child’s body, it presents unique challenges for daily care, requiring caregivers to adapt routines for hygiene, feeding, and transportation.
Defining the Spica Cast and Its Purpose
The spica cast, sometimes called a hip spica cast, is a large, rigid shell extending from the chest or waist down to include one or both legs. It is constructed using materials like fiberglass or plaster, often featuring a breathable, waterproof liner against the skin to help manage moisture. The cast is typically applied while the child is under sedation or general anesthesia to ensure proper positioning.
The extent of coverage depends on the child’s condition and the injury being treated. A single-leg spica covers the torso and one leg fully down to the ankle, while the other leg is typically casted to just above the knee. A one-and-a-half spica covers the torso and one leg, extending only to the knee of the uninjured leg. A double spica or bilateral spica fully encases both legs. A bar is often placed between the legs for structural reinforcement and to maintain the required hip abduction and rotation.
This device is primarily used for conditions requiring long-term immobilization of the hip and femur. Common applications include Developmental Dysplasia of the Hip (DDH), which involves an unstable or dislocated hip joint, and significant femur fractures in children, especially those under five years old. By stabilizing the pelvis and the thigh bone, the spica cast holds the joint in the optimal position for the bones to fuse or the hip socket to develop properly.
Daily Life and Care Routines
Caring for a child in a spica cast demands specific adjustments to everyday routines, with hygiene being a primary focus. Sponge bathing is necessary, as the cast must be kept completely dry to prevent skin irritation, odor, and structural damage to the cast material. Caregivers should use a lightly damp washcloth and mild soap on exposed skin, paying particular attention to the cast edges.
Toileting Management
A major challenge is managing toileting needs, which requires a technique often referred to as the “double-diaper” or “tuck and tape” method. A smaller diaper is carefully tucked inside the cast edges around the genital opening to create a seal, preventing urine or stool from wicking into the cast padding. A larger diaper is then placed over the outside of the cast to secure the inner diaper and provide extra absorbency. For older children, a bedpan or urinal can be used while the child is positioned upright to allow gravity to pull waste away from the cast opening.
Repositioning and Equipment
Frequent repositioning is required, typically every two to four hours, to prevent pressure sores from developing beneath the cast. Pillows and rolled towels should be used to support the child, ensuring that heels are kept elevated off flat surfaces and that the upper body is slightly elevated to aid in drainage and digestion. Adapting clothing is another necessity, with oversized shirts and dresses being the most practical options, though some parents adapt trousers by cutting the seams and using Velcro for easier dressing. Specialized equipment, like a wider-based car seat or a reclining stroller, will be required, as the rigid, abducted position of the legs prevents the child from fitting into standard seating.
Monitoring for Potential Issues
Caregivers must vigilantly monitor the child for signs of complications that could compromise healing or safety. A constant, severe pain that is not relieved by standard medication or repositioning can be a sign of a serious issue like compartment syndrome, which requires immediate medical attention. This is distinct from the normal discomfort associated with a fracture or post-surgical recovery.
Circulation Checks
Circulation checks are a routine safety protocol, examining the exposed toes and feet for signs of poor blood flow. The toes should be warm to the touch and maintain a pink color; if they become cool, pale, or bluish, or if there is excessive swelling that does not subside with elevation, a healthcare provider should be contacted. Capillary refill, which involves pressing on a toenail until it blanches and then timing how quickly the pink color returns, should take no more than two to three seconds.
Cast and Skin Integrity
The integrity of the cast and the underlying skin must also be observed daily. Foul odors, drainage, or persistent wetness coming from the cast are signs of potential skin breakdown or infection underneath the padding. Caregivers should use a flashlight to inspect the skin around the cast edges for any redness, blistering, or pressure marks. Any cracks, soft spots, or significant wetness that compromises the structural stability of the fiberglass or plaster also warrants a call to the orthopedic team.
The Removal Process and Post-Cast Care
When the treatment period concludes, the spica cast is removed using a specialized electric saw, a process that can be noisy but does not cut the skin. Healthcare providers often use ear protectors for the child and take time to explain the procedure to minimize fear.
Immediate Skin Care
Immediately after removal, the skin that was covered by the cast will likely appear dry, flaky, and scaly. Caregivers should gently soak the skin with soapy water and pat it dry, avoiding any harsh rubbing or scrubbing that could damage the tender skin. Applying a fragrance-free moisturizing cream after bathing helps restore the skin to its normal condition.
Recovery and Rehabilitation
The child’s muscles and joints that were immobilized may feel stiff and weak, and the child may experience some soreness for a few days. It is common for a child to be placed in a hip abduction brace or splint for several more weeks to gradually transition the joint and maintain the correction. Physical therapy may be prescribed to help the child regain strength, flexibility, and full function as they adjust to moving without the heavy, restrictive cast.