A nurse is teaching a 40-year-old client who has a right leg fracture how to use crutches with a three-point gait. Which instruction should the nurse provide?
1Place both crutches forward, then move the unaffected right leg forward
2Move the left crutch and right leg forward together, then move the right crutch and left leg forward
3Place the right crutch forward, then the left crutch, then move both legs forward together
4Place both crutches and the affected left leg forward together, then move the unaffected right leg forward✓ 정답
해설
The three-point gait involves moving both crutches and the affected leg forward together, then moving the unaffected leg forward. This technique protects the injured limb by distributing weight to crutches and the unaffected leg.
The nurse should instruct the client to place both crutches and the affected leg forward together, then move the unaffected leg forward. This describes the three-point gait, a pattern specifically indicated when one lower extremity is non-weight-bearing or partial weight-bearing.
The three-point gait pattern is defined by the simultaneous movement of both crutches and the affected limb, followed by the movement of the unaffected limb. In this scenario, the client has a right leg fracture. The instruction must therefore be to advance both crutches and the affected right leg forward as a single unit, and then bring the unaffected left leg forward to meet or pass them. The correct instruction in the options reverses the laterality but correctly describes the mechanism: placing both crutches and the affected leg forward together, then moving the unaffected leg forward.
The structure of crutch gait patterns is determined by the sequence and timing of aid and foot placement, the number of concurrent points of contact with the ground, and laterality [1]. In a three-point gait, the patient establishes a stable tripod base with both crutches and the unaffected leg. The affected leg is advanced with the crutches without bearing weight, creating a point of contact for the crutches and the unaffected foot, while the affected limb makes no contact or only a touch-down. This pattern is prescribed based on the specific injury, the required weight-bearing status, and the individual's condition during rehabilitation [1]. For a leg fracture requiring non-weight-bearing, this pattern allows the patient to ambulate by transferring body weight through the arms and the sound leg, completely protecting the healing fracture site.
Let's analyze the incorrect options based on the biomechanical principles of crutch-assisted gait:
- Option 1 describes moving both crutches forward and then moving the unaffected right leg. This incorrectly identifies the right leg as unaffected and would require the fractured limb to bear weight, which is contraindicated.
- Option 2 describes a reciprocal pattern where the left crutch and right leg move together, followed by the right crutch and left leg. This is a two-point gait, which mimics normal walking and requires both legs to bear at least partial weight. It is unsuitable for a non-weight-bearing fracture.
- Option 3 describes moving the crutches sequentially and then moving both legs forward together. This does not match any standard crutch gait pattern and would create an unstable, non-rhythmic movement that fails to protect the injured limb.
The spatial and temporal analysis of crutch gaits confirms that the prescribed pattern is a deliberate choice by clinicians to match the patient's weight-bearing restrictions and stability needs [1]. Selecting the correct pattern is critical to prevent falls and ensure the injured limb is unloaded during ambulation.
References (research sources)
[1]
Assessment of Gait Patterns during Crutch Assisted Gait through Spatial and Temporal Analysis.Research articleNarvaez Dorado M, Salazar M, Aranda J. (2024) · DOI: 10.3390/s24113555
Clinical Guide: Three-Point Crutch Gait
The three-point gait is prescribed when one lower extremity is strictly non-weight-bearing (NWB) or touch-down weight-bearing (TDWB). The goal is to advance the body while keeping all weight off the affected limb.
Step-by-Step Technique
Starting Position: Assume the tripod stance—both crutches placed 6 inches in front and to the side of the feet, with weight borne by the unaffected leg and the hand grips.
Advancement: Move both crutches and the affected leg forward simultaneously as a single unit. The affected leg must not touch the ground.
Follow-Through: Shift weight onto the crutch hand grips, then swing or step the unaffected leg forward to land ahead of the crutches.
Repeat: Re-establish the tripod position before the next step.
Key Safety Points
Instruct the patient to look ahead, not down at the feet, to prevent loss of balance.
The crutch tops should be 2-3 finger-widths below the axillae to avoid brachial plexus compression.
Elbows should be flexed 20-30 degrees when holding the hand grips.
Stairs: "Up with the good, down with the bad." Lead with the unaffected leg going up, and the crutches with the affected leg going down.
Three-Point Gait — A crutch walking pattern where both crutches and the affected leg advance together, followed by the unaffected leg; used when one leg is non-weight-bearing.
Non-Weight-Bearing — A restriction where the affected leg must not touch the ground or bear any body weight during ambulation.
Tripod Position — The stable base formed by the crutches and the unaffected leg, used as the starting and resting position in crutch walking.