Is it Easier if the Hip Spica Patient is in Diapers?

A reader asks:

My daughter was born with Developmental Hip Dysplasia and is having surgery in 2 weeks. She is 18 months old & I've been tearing my hair out looking for help. Thank you, thank you, thank you.

Wondering if you could answer me this ... do you think it is harder or easier in the cast if bubby is in nappies?

-Leanne

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Leanne,

Our son Akira was not toilet trained when he wore his cast, so he was in diapers the whole time. Would it have been easier if he hadn't been in diapers? I don't know, but I can't imagine it would have been.

The cast forced Akira to keep his legs straight and his body unbent; he had to lie flat. How does one negotiate a bedpan in such circumstances? You'd have to lift him, I'd guess, and keep him suspended over the bedpan while he does his business.


Akira weighed around 35 lbs. when he broke his leg. With the half-body cast he weighed closer to 50 lbs. Can you imagine trying to lift that much weight every time he needed to go pee pee? And what if you accidentally dropped him, or he inadvertently sprayed his cast?

Not that caring for a spica-cast patient in diapers was a walk in the park. The danger we faced was that the diaper would leak, either because it was ill-fitting or full, and then the cast would get stained. So we had to check the diaper often, and make sure it was always in place.

One method I've seen that has been recommended is to have the patient wear two diapers. The first diaper, with sticky tabs removed (otherwise they stick to the inside of the cast), is against the skin, over the buttocks and groin, with the ends shoved up inside the cast, in front and behind. (Or you can use a sanitary pad instead.)

The second diaper is worn over this one, but is fastened on the outside of the cast using the sticky tabs. So the outer diaper works to keep the inner diaper (or sanitary pad) in place. You may need to use a larger diaper for this outer one.

For pics on how to do this, see p.2 of this link (it's a PDF file, so give it a minute to download): http://www.vanderbiltchildrens.com/uploads/documents/ortho-hc0425.pdf

When our son first had his cast put on they had him wearing only one diaper, which was fastened on the outside of the cast (as in the second diaper mentioned above). There was no diaper or sanitary pad underneath!

This was, of course, a disaster b/c if he had wet himself it almost certainly would have stained the cast. We saw that immediately, cut the tabs off and shoved the ends of the diaper up under his cast.

Moral of the story: nurses don't always know what they're doing with hip spica cast patients, so you've got to oversee things yourself.