Executive Editor: Fergal Monsell

General Editor: Chris Colton

Authors: Andrew Howard, James Hunter, Theddy Slongo

Pediatric proximal femur 31-M/3.1 I Open reduction, K-wire fixation

Hip spica


Hip spica is only likely to be used in the treatment of small children with proximal femoral fractures.

For larger children, internal fixation should be used even for nondisplaced fractures.

Immediate care

After application, the spica should be trimmed to allow adequate space for bodily functions. The edges of the spica should be padded and waterproofed.

Diaper care

Generally, a hip spica should allow space for a small diaper inside the plaster and a large one outside the plaster. The diapers should be positioned to prevent soiling of the spica.


The spica is not waterproof. Bathing and showering should not be attempted. Hair washing should be done very carefully.

Skin care

No skin products should be put inside the spica. Only skin that can be seen should be moisturized.


Both the child and the spica must be lifted. A special car seat will be required. The child may be placed in a stroller or buggy.

In this circumstance, the parents/carers are advised to return to the healthcare provider.

Length of time in spica

The length of time in the spica depends on the age of the child and the healing of the fracture . A proximal femoral fracture in a child aged below 4 years should always be healed in 6 weeks.


The child will continue to grow and the tightness of the spica should be monitored.

Follow-up x-rays

Nondisplaced fractures being treated nonoperatively should have early radiological follow-up. If the spica is being used for protection of fixation, x-rays are required only when planning removal.




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v1.0 2017-12-04