Immobilisation - Crutches

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Indications

Unable to weightbear on one leg due to injury or pain

Contraindications (absolute in bold)

Age <8 years

Age >70 years

Impaired upper limb function, co-ordination or balance

Alternatives

Walking stick

Frame

Stroller or child walker

Informed consent

Verbal consent

Less complex non-emergency procedure with low risk of complications

Potential complications

Brachial plexus injuries (from compression at axilla)

Strains of wrist, elbow, shoulder

Procedural hygiene

Standard precautions

Area

Anywhere

Staff

Procedural clinician

Equipment

Axillary crutches (small, medium or large size)

Positioning

Fit to standing patient with elbows flexed to 30 degrees

Adjust crutch height to three fingers below axilla

Adjust handle to level of wrist crease (using non-injured side)

Sequence (with or without partial weightbearing, dependent on injury)

Place crutches on each side between arm and trunk

Bring both crutches forward with injured leg

Lean through arms to reduce weight through injured leg

Step forward with uninjured leg

Upstairs: uninjured limb takes each step, followed by the crutches and injured limb

Downstairs: crutches and injured limb take each step, followed by the uninjured limb

Post-procedure care

Test mobility over at least 10 metres to ensure patient comfortable

Educate on weightbearing status (weightbear as tolerated, non-weightbear)

Educate on stairs

Tips

Weightbearing should be through the arms and wrists, not the axilla (to avoid nerve injury)

Crutches always move with or just before the injured limb

Keep injured foot moving in line with crutches to aid balance

Peer review

This guideline has been reviewed and approved by the following expert groups:

Emergency Care Institute

Please direct feedback for this procedure to ACI-ECIs@health.nsw.gov.au.

References

NSW Agency for Clinical Innovation. Orthopaedic/musculoskeletal. Sydney: ACI; 2020. Available from https://www.aci.health.nsw.gov.au/networks/eci/clinical/clinical-resources/clinical-tools/orthopaedic-and-musculoskeletal

Roberts JR, Custalow CB, Thomsen TW. Roberts and Hedges’ clinical procedures in emergency medicine and acute care. 7th ed. Philadelphia, PA: Elsevier; 2019.

Dunn RJ, Borland M, O’Brien D (eds.). The emergency medicine manual. Online ed. Tennyson, SA: Venom Publishing; 2019.

Eiff MP, Hatch R. Fracture management for primary care. 3rd ed. Philadelphia PA: Saunders; 2011.

Stracciolini A. Basic techniques for splinting of musculoskeletal injuries In: UpToDate. Waltham (MA): UpToDate. 2019 April 18. Available from: https://www.uptodate.com/contents/basic-techniques-for-splinting-of-musculoskeletal-injuries

Liverpool hospital emergency department: Plaster booklet (2019)

© Agency for Clinical Innovation 2021

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