Virtual Conference

Elinor Berger

Baylor Scott and White Roney Bone and Joint Institute, USA

Title: Waterproof liners for hip spica casts reduce unplanned healthcare encounters


Cotton liners, traditionally used in cast applications, trap moisture and chemical irritants such as urine, stool, and sweat resulting in adverse skin reactions, unplanned emergency and nursing visits, cast adjustments, readmissions, and return to the operating room for cast change under anesthesia (Shirley et al., 2020). Complications associated with hip spica casts result in unplanned healthcare encounters in excess of standard of care (DiFazio et al., 2011).

This quality improvement project evaluated implementation of the current American Academy of Orthopaedic Surgeons (2020) hip spica cast liner guideline to reduce excess healthcare encounters associated with hip spica cast complications. The primary objective of this project was to identify if the use of a waterproof hip spica cast liner will reduce unplanned healthcare encounters related to hip spica cast complications.

A retrospective chart review was used to measure and compare the incidence of excess healthcare encounters associated with cotton and waterproof hip spica liners. Retrospective review of the electronic health record (EHR) identified pediatric patients between the ages of six months and six years of age who required a hip spica cast for the treatment of a diaphyseal femur fracture from January 1, 2020 through April 30, 2021.

Unplanned healthcare encounters during the 90-day period beginning with hip spica cast application and abnormal skin assessment at cast removal was quantified using EHR review of hip spica casts that utilized cotton or waterproof liners. Chi-squared test showed statistically significant reduction in unplanned healthcare encounters and cast complications associated with waterproof hip spica cast liners. Utilization of waterproof hip spica cast liners decreased unplanned healthcare encounters by 100% (n= 28) and significantly reduced skin complications associated with hip spica cast treatment.


Elinor Berger has been a pediatric nurse practitioner for 15 years and in the field of pediatric orthopedic surgery for the past 7 years. She emphasizes translation of evidence into practice and education of medical and nursing students as well as continuing provider education in pediatric orthopedics. In addition to prior leadership roles in professional societies, she is currently a member at large on the pediatric orthopedic practitioner society board. She received her DNP in 2021, MSN in 2008, BSN in 2005, and BS in 2002.