A patient with fracture of left tibia is using crutches for walking. A complication as a result of improper use of crutches for which regular assessment should be done is:

1. A

   Venous thrombosis

2. B

   Foot drop

3. C

   Wrist drop

4. D

   Cervical spondylosis

Appeared in: GMCH - 2016

Explanation

• Improper use of axillary crutches involves bearing weight on the armpits (axillae) instead of the hands.
• This axillary pressure compresses the radial nerve, which runs through the armpit area.
• Compression of the radial nerve leads to a condition called 'crutch palsy' or neuropraxia.
• The primary sign of radial nerve palsy is wrist drop, which is the inability to extend the wrist and fingers due to muscle weakness.

Why Other Options Were Wrong

• Option A: Venous thrombosis is a complication of immobility and venous stasis related to the fracture and reduced activity, not a direct result of improper crutch use.
• Option B: Foot drop is caused by damage to the peroneal nerve, typically from pressure around the knee (e.g., from a tight cast or improper positioning). It is not caused by pressure in the axilla from crutches.
• Option D: Cervical spondylosis is a degenerative disease of the cervical spine (neck) and is unrelated to acute injury or the use of crutches for a leg fracture.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Complications of Improper Crutch Use to guide bedside assessment, documentation, and the next nursing action.
• A nurse's primary role is patient education on the safe use of assistive devices to prevent secondary complications like nerve damage.
• Regular neurovascular assessment of the upper limbs is critical for any patient using axillary crutches, checking for sensation, motor function (especially wrist extension), and color.
• What if the patient complains of tingling and numbness in their 4th and 5th fingers (ring and pinky)? This would suggest ulnar nerve compression, which can also occur from pressure on the handgrips, and would require adjusting hand position or padding the grips.

How to Approach the Question

• First, identify the key elements of the question: an assistive device (crutches), an action (improper use), and a resulting complication.
• Focus on the anatomical location of 'improper use'. For axillary crutches, this means pressure in the axilla (armpit).
• Recall or deduce the major nerves that pass through the axilla, primarily the brachial plexus, with the radial nerve being particularly vulnerable to compression against the humerus.
• Connect the nerve to its function. The radial nerve is responsible for wrist and finger extension.
• Evaluate the options: 'Wrist drop' is the direct clinical sign of radial nerve palsy. The other options relate to different causes (immobility, peroneal nerve) or are unrelated chronic conditions.

Concept Tested & Keywords

• Concept Tested: Complications of Improper Crutch Use
• Stem keywords: fracture, tibia, crutches, improper use, complication
• Lead-in keywords: complication as a result of
• Clinical cues: Use of crutches for a lower limb fracture points to potential upper body complications from the assistive device.
• Negative lead-in flag: false

Question ID

QIlT5lgNgDpCpopesflJWi

Copy ID

Reference Book

E6 Nursing Fundamentals Potter Perry 12e Part 4 p. 105-107