489 Bivalve Spica Casting for Hip Flexion Contractures in Pediatric Burns

Abstract Introduction Hip extension limitations are a common issue in our pediatric burn unit although their occurrence is not well documented in the literature. If untreated, these limitations can lead to chronic hip flexion contractures that result in abnormal gait patterns and inability to stand with erect posture. In children, these contractures could also lead to alteration of bony development. A review of published hip splinting techniques includes the thermoplastic anterior hip splint and the bivalve thermoplastic trunk/hip splint. Bivalve spica casts for post-op and nighttime splinting represent a cost-effective and valuable tool to provide a sustained stretch to the anterior hips. This report aims to share preliminary results from a quality assurance project looking at a series of patients who utilized this cast and to explain how the bivalve spica cast is made. Methods The bivalved spica cast was used on 10 patients. The average patient age was 6y4m (range 1y11m to 11y). Patients were primarily selected for casting if they had not responded to less restrictive splinting (thermoplastic anterior hip splint, abduction wedge) or positioning. Nine of these patients were inpatient at the time of casting. Six patients were casted in the OR under sedation and 4 patients were casted while awake. Fiberglass casting was performed by a orthopedic technician with a physical therapist assisting with positioning. A child life specialist was present when the patients were awake to provide comfort and distraction. All casts were bivalved, lined with waterproof tape along the edges, and had straps and buckles attached. All patients were discharged home with the cast to be used while sleeping at night in prone or supine. Results Patients who used the bivalve spica casts showed improvement in hip range of motion as measured either goniometrically (average increase in hip extension was 10° with a range of 0°to 25°) or functionally (i.e. improved gait mechanics, ability to lie prone). One cast was broken (due to moisture) and had to be remade. There were no complications reported. Conclusions The bivalve spica cast is a valuable splinting tool for the management of post-burn pediatric hip flexion contractures. The cast is easily fabricated and does not require expensive materials. Casting is most successful with a team approach. Drawbacks include the time involved to coordinate team members as well as the cast not being waterproof. Applicability of Research to Practic