Under general anaesthesia (usually combined with the surgical procedure), the child is positioned on a spica frame. Padding is applied over bony prominences. Fibreglass or plaster of Paris casting material is applied from the upper chest, around the hips, and down to one leg (single spica) or both legs (double spica). The hips are positioned in the desired angle of flexion and abduction. A window may be cut for wound access. The cast takes 20–30 minutes to apply and sets within 30 minutes.
Spica casts are used for femoral shaft fractures in children under approximately five years (who are too young for nailing), post-operative immobilisation after DDH surgery (open reduction, pelvic or femoral osteotomy), and post closed reduction of DDH.
For femoral fractures in older children: flexible nailing (TENS). For DDH: Pavlik harness in infants under six months.
Parents are counselled extensively on spica care — feeding, hygiene, nappy management, and car seat requirements (special car seats may be needed). The child may stay in hospital for one to two days after application to ensure the family is confident with care.
Effective immobilisation of the hip and femur. For femoral fractures: healing in three to four weeks. For DDH: maintains reduction while the hip stabilises.
Skin irritationCommon
Redness, rubbing, or breakdown under the cast, particularly around the groin and waistline.
Hygiene challengesExpected
Nappy management and bathing are difficult. Parents need detailed instruction.
Child distressCommon
Some children are initially distressed by the restriction. Most adapt within days.
Cast soilingCommon
Keeping the perineal area clean and dry is challenging.
Pressure soresUncommon
If the cast is too tight or padding is inadequate.
Compartment syndromeRare
Very rare in spica casting.
Vascular compromiseRare
If the cast is too tight around the thigh.
Cast syndromeRare
Superior mesenteric artery syndrome — abdominal distension, vomiting, and pain from compression of the duodenum. Rare but serious.
Skin infectionUncommon
Under the cast from soiling.
Applied under the same general anaesthetic as the surgical procedure. Alternatively, applied under sedation for non-surgical indications.
Cast worn for three to twelve weeks depending on the indication. Regular position changes to prevent pressure sores. The cast may be replaced (cast change) under anaesthesia if it becomes soiled or damaged. After cast removal, the child's joints are initially stiff but recover rapidly — children are remarkably resilient. Formal physiotherapy is rarely needed.
X-ray within one week to confirm position. Cast removal at the planned time. Post-removal X-ray. Clinical review.
How do I manage nappies?
Place the nappy inside the cast, tucking it carefully around the perineal window. Change frequently. Waterproof cast edges with moleskin or plastic wrap may help. Your nursing team will demonstrate the technique before discharge.
Can my child sit in a car seat?
Standard car seats do not accommodate a hip spica. A modified car seat or travel bed may be needed. Your occupational therapist will advise on safe transport options.
How will my child cope?
Most children adapt surprisingly quickly — within a few days. They find ways to play, roll, and move within the cast. The first few days are the hardest for both child and parents. Support is available from the nursing and play therapy teams.