Crutches and crutch walking

Encyclopedia of Nursing and Allied Health, , by R.N. Mary Elizabeth Martelli, B.S.

Definition

Crutches are orthopedic devices created to assist in weight bearing when a patient has a leg injury or weakness in the lower extremities.

Purpose

Wooden or aluminum axillary (under the arm) crutches are used to assist in weight bearing when a patient has sustained an injury to the leg, knee, ankle, or foot, such as a fracture or severe sprain. Crutches are also used following surgery on the leg, knee, ankle, or foot. Forearm crutches are used to provide stability and moderate support when a patient has generalized weakness in the lower extremities, such as for a patient with cerebral palsy.

Description

Axillary crutches can be either wooden or aluminum. Each crutch is comprised of two pieces of wood or aluminum that are connected at the top and middle by a crossbar and join to a third piece that extends to the floor. The top cross bar is slightly concave in shape and fits just 1-2 inches (2.54-5 cm) below the axilla. It is covered with a soft rubber pad and is used to brace the crutches against the body. The middle cross bar is round and covered with a rubber grip. It is adjusted to hand level for gripping the crutches with the hands. The third piece connects the two upper pieces, extends to the floor, and is covered by a rubber tip on the end that meets the floor. Crutches are used in pairs to provide balance and support. Aluminum crutches are lighter and easier to use. Wooden crutches are generally less expensive than aluminum crutches.

Forearm crutches are comprised of two pieces of aluminum tubing that are telescoped one within the other to adjust to the correct height of the client. They are fitted with attached, swivel-action arm cuffs that fit partially around the forearm, and with handgrips that are covered with a rubber grip. There is a rubber tip at the end of each crutch where it meets the floor.

Operation

Wooden or aluminum axillary crutches come in several sizes. The appropriate size crutches should be selected based on the patient's height. With the patient standing straight upright, one crutch is held against the patient's side. The nut bolt which attaches to the bottom piece is loosened and removed. The crutch is then adjusted until it is l-2 inches (2.54-5 cm) below the patient's axilla. The bolt is placed in the appropriate hole, and the nut wing is tightened securely to hold it in place. The patient then holds his hand down with the elbow slightly bent. The bolt and nut wing for the handgrip are loosened and moved to the correct position for the patient. The hand should be resting at the hip line with the elbow slightly bent. The bolt is placed in the appropriate hole, and the nut wing is tightened securely. The rubber tip, rubber axillary padding, and rubber handgrip are checked to ensure placement and security. The client sits back down, and the other crutch is adjusted at the base and the hand grip to exactly match the measured crutch.

Aluminum forearm crutches come in several sizes. The appropriate size crutches should be selected based upon the patient's height. With the patient standing, one crutch is adjusted by pushing in the locking mechanism and moving the height up until the forearm portion of the crutches can slip comfortably onto the patient's arm. The crutches are locked by moving the mechanism until the lock clicks securely. The arm cuff is adjusted if necessary. The crutch is checked for stability by pushing down on it. The vinyl padding on the arm cuff, the rubber handgrip, and the rubber tip at the end of the crutch are examined to be sure they are in place and secure. The client then sits back down, and the other crutch is adjusted to exactly match the measured crutch.

The patient should not attempt to use the crutches until they are fitted and all of the nut wings or locking mechanisms are secure. The hands and arms bear the patient's weight, not the axilla. The patient is instructed not to lean on the axillary pads because this can pinch the axillary nerve and cause numbness of the hands and arms. The patient is instructed on crutch safety, how to walk with crutches, how to go up and down stairs with crutches, how to sit, and how to stand up using the crutches. The patient demonstrates competency with the crutches before discharge. The patient is given written instructions about crutch walking and safety to review later after discharge.

Maintenance

The screw bolts and nut wings that hold the base of the crutches and the handgrip of the crutches should be checked daily to be sure they are securely tightened. Rubber tips that become worn or tear should be replaced at once to prevent slipping. Rubber handgrips that are torn or worn should be replaced promptly to prevent blisters on the hands or slipping of the hands. Worn or torn rubber padding at the top of axillary crutches should be replaced to prevent pressure injuries. New rubber tips or handgrips can be purchased at most drug stores. Crutches that are kept in good repair can be reused if well maintained but should be re-measured and adjusted for each client. Forearm crutches should be checked daily before use to be sure that the height adjustment pegs are secure, the swivel-action arm cuffs fit correctly, the rubber tips are intact, and the handgrips are secure.