Sports Medicine Book

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Crutches

Aka: Crutches, Axillary Crutches, Forearm Crutches, Canadian Crutches, Lofstrand Crutches
  1. See Also
    1. Mobility Device
    2. Assistive Technology
    3. Canes
    4. Walkers
  2. Indication
    1. Gait disturbance (full weight bearing)
  3. Advantages
    1. Significant weight bearing support (80% for one crutch and 100% for two Crutches)
  4. Disadvantages
    1. High energy expenditure and upper body strength requirement
    2. Unsuitable option for frail elderly
  5. Types
    1. Axillary Crutches
      1. For temporary use (acute injuries)
      2. Adjustable aluminum or wooden Crutches
      3. Requires significant upper body strength
      4. May be difficult to use and cumbersome
      5. Risk of nerve or artery compression in axilla if incorrectly used
    2. Forearm Crutches (Canadian crutch, Lofstrand crutch)
      1. For active patients with severe leg weakness
      2. Offers easier mobility than with Axillary Crutches
      3. Brace fixes crutch to Forearm and hands grasp handles
        1. Allows use of hands without dropping Crutches
        2. Less cumbersome on stairs than axillary crutch
  6. Technique
    1. Two point
      1. Advance left crutch and right leg together, then
      2. Advance right crutch and left leg together
    2. Four point (most stable)
      1. Crutches and legs move independently
      2. Advance left crutch
      3. Advance right leg
      4. Advance right crutch
      5. Advance left leg
  7. Fitting
    1. Axillary Crutches
      1. Elbows bent to 30 degrees flexion while holding crutch handles
      2. Crutch base sits 6 inches anterior and 2 inches lateral to foot
      3. Allow adequate space between top of crutch and axilla
        1. Crutch top should have a space of 4-5 cm (~2 inches) below axilla
        2. Axilla should not rest on top of crutch
    2. Forearm Crutches (Canadian crutch, Lofstrand crutch)
      1. Plant crutch end in front of foot by 6 inches
      2. Keep elbow slightly flexed to 15 to 30 degrees
      3. Place cuff at proximal Forearm just distal to elbow (2.5 to 4 cm below the olecranon)
  8. References
    1. Bradley (2011) Am Fam Physician 84(4): 405-11 [PubMed]
    2. Van Hook (2003) Am Fam Physician 67(8):1717-24 [PubMed]

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