Closed Reduction of the Hip

The patient is taken to the operating room for a closed reduction of the hip.  The patient is put to sleep with the help of the anesthesia team.  The patient has x-rays in the room.

The patient is placed into a SPICA cast.  They are in this cast for approximately 4-6 weeks initially.

The cast is changed at increments.  Each time, this is done in the operating room.  The total cast time varies for each patient.  The total cast time can last up to 3 months. 

The patient is then transitioned into a brace. 

Occasionally, an arthrogram is performed. This is when dye is injected into the hip to view the location of the closed reduction.  This is often done in conjunction of a CT or MRI.

Care Seat Options with the Cast
We always try your seat from home.  Sometimes, we have luck!  If not, we have a few loaner car seats available. 

Transportation
Patients usually can fit in a regular stroller, umbrella stroller or a wagon. If the above options do not work, we can order a pediatric wheelchair.

SPICA Cast Care
General Cast Care:  Handle the cast as little as possible during the first 24 hour drying time.  It will dry more quickly if kept uncovered. 

Pink waterproof tape has been used to bind the edges of the cast. 

Avoid getting the cast wet as it will soften and become odorous.  If the cast does become damp, dry it by using a hair dryer on the COOL setting. Make sure it thoroughly dries before applying weight to it.

The cast may be autographed with markers, but do not paint it with anything. 

Avoid putting any objects, powders, or creams onto the cast or the skin.

Skin Care
Keep the skin around the cast clean and dry.  Change diapers frequently (about every 2 hours) to help prevent skin irritations.

DO NOT POKE ANY objects to scratch an itchy are of the skin. This may cause skin injury and infection.

Reach under the cast frequently to pull out plaster, food crumbs, or other objects. These items can cause pressure areas and irritation.

Positioning
Turn your child about every 2 hours during the day.

Aids for positioning: Bean bag chair, pillows, wagon or SPICA chair.

You may have to reposition your child at night time to ensure comfort.

Checking Circulation
Check your child's toes several times a day and look for the following signs:
    Is he/she able to wiggle toes?
    Are they warm and pink?
    Is there any swelling or discoloration (blueness)?
    Does he/she complain of numbness or pain? For a child who is not able to communication... is he/she fussy for no apparent reason?

If you notice a loss of sensation (feeling) or movement, coolness, swelling, discoloration, or excessive pain, notify the office. The numbers are listed below.

Diapering
The pink tape around the edge of the cast helps prevent urine from soaking into cast from the diaper. Apply new tape as needed. Apply small (approximately 2 to 3 inches long), pieces of pink tape on the edges of cast. Each petal should overlap the previous petal to form a smooth neat edge.

 

Please note if your child has a latex allergy, white foam tape will be used.

 

To diaper, please use the smaller diaper tucked in smoothly into the cast next to the skin. You may choose to use a sanitary pad for more absorption. Then place the larger diaper on the outside over the cast.

 

Changing diapers frequently will prevent the cast from being wet. It may be best to change diapers every 2-3 hours during day.

 

Place a pillow under the mattress at the head of the bed in your child’s crib. The slight elevation will prevent the urine and stool from running up into the cast.

CONTACT INFORMATION:
Monday-Friday during business hours:  Office 314-454-2500
After Hours Medical Exchange: 314-388-5550

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