# A nurse is teaching a 25-year-old client with a left ankle fracture how to use crutches. Which instruction should the nurse provide for proper crutch walking technique?

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## 문제

A nurse is teaching a 25-year-old client with a left ankle fracture how to use crutches. Which instruction should the nurse provide for proper crutch walking technique?

## 보기

1. Place both crutches forward, then move the injured left leg, followed by the right leg
2. Move the right crutch and left leg together, then move the left crutch and right leg together
3. Place the left crutch forward with the right leg, then move the right crutch with the left leg
4. Move both crutches forward together with the injured left leg, then step forward with the right leg **✔ 정답**

**정답: 4**

## 해설

The three-point gait (both crutches and injured leg move together, then unaffected leg) provides maximum stability and non-weight-bearing for a leg fracture. Other options are incorrect techniques that could compromise safety.

## 심화 해설

Understanding the Three-Point Gait for Non-Weight-Bearing

For a client with a left ankle fracture who has been prescribed a non-weight-bearing status, the correct crutch walking technique is the three-point gait. The instruction to "move both crutches forward together with the injured left leg, then step forward with the right leg" describes this pattern precisely. The goal is to maintain complete off-loading of the injured extremity while providing a stable base of support during ambulation.

Biomechanical Rationale and Weight-Bearing Restrictions

The primary reason this technique is selected over other gaits relates directly to the healing process of the fractured bone and the biomechanical forces that can disrupt it. After surgical fixation of an ankle fracture, the integrity of the repair is vulnerable to mechanical stress. Research on early postoperative rehabilitation emphasizes that specific physiotherapy exercises generate varying degrees of in vivo joint loads . During ambulation, even with assistive devices, the ground reaction force transmitted through the lower extremity can be substantial. By advancing the injured leg simultaneously with both crutches, the client creates a tripod of support—two crutches and the uninjured right leg—that fully suspends the left foot off the ground. This prevents any axial loading or rotational stress on the healing ankle mortise, which is critical for maintaining the reduction achieved during surgery .

Clinical Application of the Three-Point Gait Sequence

The sequence must be taught methodically to ensure safety and compliance. The nurse should instruct the client to begin in the tripod position, which is the starting stance where the crutches are positioned slightly ahead and to the side of the body, with weight borne on the uninjured right leg. The movement is then broken down into two phases:

1.  Crutch-Injured Leg Phase: The client moves both crutches forward a comfortable distance (approximately 6 to 8 inches), simultaneously bringing the injured left leg forward so that the left foot is in line with, but not bearing weight beyond, the crutch tips. The body weight remains entirely on the right leg and is partially supported by the arms on the crutches.

2.  Uninjured Leg Phase: The client then shifts their weight onto the hand grips of the crutches and swings or steps the strong, uninjured right leg forward, placing the foot flat on the ground just ahead of the crutches. This step returns the client to the stable tripod position, ready to begin the next sequence.

This pattern is distinct from the two-point or four-point gaits, which require partial weight-bearing on both legs and are contraindicated when a strict non-weight-bearing order is in place. The other options presented are incorrect because they either pair a crutch with the injured leg in a reciprocal pattern (which would force the injured leg to accept weight) or describe a swing-to gait that does not isolate the injured limb’s forward movement with the crutches as a single, protected unit.

Connecting Immobilization and Functional Recovery

The choice of gait directly supports the broader rehabilitation goals following ankle fracture fixation. Studies comparing postoperative immobilization methods, such as casts versus removable boots, highlight that early mobilization protocols are designed to improve functional outcomes, measured by tools like the Olerud and Molander Ankle Score . However, "early mobilization" in this context refers to controlled, non-weight-bearing or touch-down weight-bearing movement, not unrestricted walking. The three-point gait is the foundational skill that allows for safe, early mobilization while protecting the surgical site. Furthermore, long-term quality of life after ankle fracture surgery is associated with the recovery of physical functions like ankle dorsiflexion range of motion . Adhering to the correct non-weight-bearing gait in the initial phase prevents complications such as hardware failure or loss of reduction, which would otherwise delay the progression to the weight-bearing exercises necessary to regain this range of motion [3,4].

## 임상 시나리오

Three-Point Crutch GaitNon-Weight-Bearing Ambulation
Instruct the client to start in the tripod position. Advance both crutches and the injured leg forward simultaneously, keeping the injured foot off the ground. Then, step through with the uninjured leg, placing it just ahead of the crutches.

This pattern creates a stable base of support using the two crutches and the strong leg, allowing the client to bear all weight on the hands and arms. The crutches should be positioned 4–6 inches to the side and front of the feet.

CautionNever allow the injured foot to touch the floor during the swing phase. Ensure the client does not rest their axillae on the crutch pads to prevent radial nerve damage. The uninjured leg must not hop, but step forward normally.

## 핵심 개념

- **Three-Point Gait** — A crutch walking pattern where both crutches and the injured leg advance together, followed by the uninjured leg, used for non-weight-bearing on one extremity.
- **Non-Weight-Bearing** — A restriction where absolutely no weight is placed on the affected limb; the foot must not touch the ground during ambulation.
- **Tripod Position** — The crutch stance where the crutches are placed 6 inches in front and to the side of the feet, forming a wide base of support.

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