Technique of spica cast application. A, Patient is placed on child’s fracture spica table. Leg is held in about 45 degrees of flexion at hip and knee, with traction applied to proximal calf. B, One and one-half spica cast is applied down to proximal calf. Molding of thigh is done during this phase. C, Radiographs of femur are obtained, and any necessary wedging of cast can be done at this time. D, Leg portion of cast and cross-bar are applied. Belly portion of spica cast is trimmed to umbilicus. (Redrawn from Mubarak SJ, Frick S, Sink E, et al: Volkmann contracture and compartment syndromes after femur fractures in children treated with 90/90 spica casts, J Pediatr Orthop 26:567, 2006.) SEE TECHNIQUE 36.29.