Examples of plaster casts
Broomstick plaster
Both legs are encased in plaster and a bar is fixed between the 2 legs to form the shape of an ‘A’. Both legs are held apart keeping the hip joints in abduction – the best position for healing. The casts cannot be taken off at all. The casts are removed at review appointments every few weeks when the joint is assessed; the cast is reapplied if necessary before the child goes home. After some months plaster may be replaced by an orthotic brace designed to do the same job. This treatment is rarely used in the UK because of its effects on mobility.
Effect on mobility and care needs
A child in broomstick plasters will be unable to walk normally. If they can weight bear to mobilise they will need crutches to get around. Mobilising with crutches in this type of plaster is tiring and the child may require a wheelchair for longer journeys and at school. Seating is difficult and adapted seating to accommodate the legs may be needed at school and at home too. Getting on and off a toilet may be difficult, if help is needed the parent is likely to accompany the child to school to provide such help. At home the parent is likely to provide help with both washing and dressing, the child will not be able to manage their shoes and socks and may need help with other aspects of washing and dressing related to their casts.
Hip spica
A plaster cast is applied around the lower body and the affected leg, holding the hip joint in abduction (movement of the limbs away from the body). This type of plaster may be used for 4-8 weeks after surgery or whilst a brace is being custom made. It is not likely to be used for longer than this. Most children will not be able to walk or weight bear in the hip spica.
Orthotic brace
Braces are custom-made and fitted to the individual child. If used they will be worn for at least 12 months. Most braces used in this condition will consist of a waist belt attached to cuffs designed to fit round the thighs and hold the legs apart. Pictured below is an example of the Scottish Rite Brace - most braces used in Perthes disease are based on this design.
Braces are designed to be worn all of the time but are designed to be taken off for washing and bathing and for swimming which is encouraged. Braces are individually designed and may be more or less restrictive depending on the extent of disease. It will be more difficult for a child to walk and run around in their brace if both hips are affected and they may require crutches. Most children will be able to walk in their brace but this will be slow and awkward even with the aid of crutches. This treatment is rarely used in the UK because of its effect on mobility.
Effect on mobility and care needs
The child will be able to walk awkwardly and slowly in the brace, most children will do this with the aid of crutches. They will be able to get on and off the toilet by themselves and are unlikely to require help with this during the school day unless they are unable to walk.
The brace can be removed so the child can wash and a parent or carer will have been taught how to do this and will supervise the child during washing and bathing and reapply the brace afterwards. The parent will need to remove and refit the brace whenever the child gets changed, washes or goes swimming and supervise the child the whole time the brace is off effectively either helping with or carefully supervising all washing and dressing. No other help with therapy is required during the period in the brace this is because physiotherapy is not routinely used at the same time. Treatment time in the brace is normally at least 12 months.
Picture. A boy wearing a Scottish-Rite Brace.
Reproduced with the kind permission of Dr Nuno Craveiro Lopes. Hospital Garcia de Orta, Almada, Portugal.
