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Wheeless' Textbook of Orthopaedics

Wheeless' Textbook of Orthopaedics

C.R. Wheeless MD

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Wheeless' Textbook of Orthopaedics

Hip Spica Cast:


- Algorithm for Treatment:
     -  < 2    yrs :
     - 2-10  yrs:
     -  > 10  yrs :

- Contraindications:
     - unacceptable shortening or angulation;
     - open fractures;
     - thoracic or intra-abdominal trauma;

- Position of Spica:
     - place affected thigh in 10 deg of abduction or in neutral position
          w/ opposite hip in moderate abduction to facilitate perineal hygiene;
     - to decrease muscle forces & to minimize amount of shortening, place the
          lower extremity in the relaxed position;
          - w/ hip flexion, abduction, external rotation & knee flexion;
          - common mistake is to place the fractured thigh in marked abduction
                 w/ resulting lateral bowing due to the pull of strong adductors;
          - consider placing the limb in the correct position before application of Spica;
     - Proximal 1/3 Frx:
          - Hip Flexion   :     45 deg
          - Hip Abduction:   30 deg
          - Ext Rotation:      20 deg
     - Mid Shaft Fractures:
          - Hip Flexion:        30 deg
          - Hip Abduction:   20 deg
          - Ext Rotation:      15 deg
     - Distal 1/3 Frx:
          - Hip Flexion:        20 deg
          - Hip Abduction:   20 deg
          - Ext Rotation:      15 deg

- Technique Pearls: Padding:
     - its useful to place 2 layers of body stockingette over the patient's torso;
           - after a window has been cut over the abdomen, one stockingnette can be
                  cut transversely and one can be cut vertically, with each stockingette
                  arm (and the overlying sheet cotton) pulled across the sharp edges of the cut out window
           - the outer stockingette in left long over the buttocks;
                  - after the cast overlying the buttocks has been windowed, the
                         outer stockingette can be pulled upwards bringing the
                         sheet cotton across the edge of the fibroglass;
     - Gortex soft wrap is preferable to cotton wrap;
     - soft wrap (preferably Gortex) is placed, w/ care to evenly spread the cotton across the
           back and buttochs (including sacrum);
     - a thick belt of felt is taped across the chest, just below the nipple line;
     - a second felt belt is fashioned to cover the sacrum, PSIS, and ASIS;

- Reduction:
     - prior to reduction, apply short leg cast to injured side and apply cast to
             the torso and uninjured leg, leaving the injured thigh free;
     - reduction is carried out under flouroscopy;
     - usually a combination of hip flexion and distraction is required;
     - distal femoral traction pin is inserted if fracture needs
             to be brought out to length;
     - following reduction, the affected thigh is casted and joined to the previously
             applied cast;
     - w/ minimally displaced fractures, consider applying a long leg cast first, 
             followed by application of the hip spica;

- Cast Care:
     - goretex liner allows the child and the cast to be washed;
     - a panty shield napkin can be applied to the perineum to prevent soiling
            of the cast;
     - child is seen every 2 weeks for evidence of skin break down;

---------------------------
    

    

 

---------------------------
 Improved treatment of femoral shaft fractures in children. The
     "pontoon" 90-90 spica cast.

 Long-term results in the treatment of femoral-shaft fractures in
     young children by immediate spica immobilization.

 Immediate spica cast system for femoral shaft fractures in infants and
    children.



Hip Spica Cast:


- Algorithm for Treatment:
     -  < 2    yrs :
     - 2-10  yrs:
     -  > 10  yrs :

- Contraindications:
     - unacceptable shortening or angulation;
     - open fractures;
     - thoracic or intra-abdominal trauma;

- Position of Spica:
     - place affected thigh in 10 deg of abduction or in neutral position
          w/ opposite hip in moderate abduction to facilitate perineal hygiene;
     - to decrease muscle forces & to minimize amount of shortening, place the
          lower extremity in the relaxed position;
          - w/ hip flexion, abduction, external rotation & knee flexion;
          - common mistake is to place the fractured thigh in marked abduction
                 w/ resulting lateral bowing due to the pull of strong adductors;
          - consider placing the limb in the correct position before application of Spica;
     - Proximal 1/3 Frx:
          - Hip Flexion   :     45 deg
          - Hip Abduction:   30 deg
          - Ext Rotation:      20 deg
     - Mid Shaft Fractures:
          - Hip Flexion:        30 deg
          - Hip Abduction:   20 deg
          - Ext Rotation:      15 deg
     - Distal 1/3 Frx:
          - Hip Flexion:        20 deg
          - Hip Abduction:   20 deg
          - Ext Rotation:      15 deg

- Technique Pearls: Padding:
     - its useful to place 2 layers of body stockingette over the patient's torso;
           - after a window has been cut over the abdomen, one stockingnette can be
                  cut transversely and one can be cut vertically, with each stockingette
                  arm (and the overlying sheet cotton) pulled across the sharp edges of the cut out window
           - the outer stockingette in left long over the buttocks;
                  - after the cast overlying the buttocks has been windowed, the
                         outer stockingette can be pulled upwards bringing the
                         sheet cotton across the edge of the fibroglass;
     - Gortex soft wrap is preferable to cotton wrap;
     - soft wrap (preferably Gortex) is placed, w/ care to evenly spread the cotton across the
           back and buttochs (including sacrum);
     - a thick belt of felt is taped across the chest, just below the nipple line;
     - a second felt belt is fashioned to cover the sacrum, PSIS, and ASIS;

- Reduction:
     - prior to reduction, apply short leg cast to injured side and apply cast to
             the torso and uninjured leg, leaving the injured thigh free;
     - reduction is carried out under flouroscopy;
     - usually a combination of hip flexion and distraction is required;
     - distal femoral traction pin is inserted if fracture needs
             to be brought out to length;
     - following reduction, the affected thigh is casted and joined to the previously
             applied cast;
     - w/ minimally displaced fractures, consider applying a long leg cast first, 
             followed by application of the hip spica;

- Cast Care:
     - goretex liner allows the child and the cast to be washed;
     - a panty shield napkin can be applied to the perineum to prevent soiling
            of the cast;
     - child is seen every 2 weeks for evidence of skin break down;

---------------------------
    

    

 

---------------------------
 Improved treatment of femoral shaft fractures in children. The
     "pontoon" 90-90 spica cast.

 Long-term results in the treatment of femoral-shaft fractures in
     young children by immediate spica immobilization.

 Immediate spica cast system for femoral shaft fractures in infants and
    children.



 
 
 
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