Orthopedic Skills:
Crutch Training, CPM, Stump Wrapping, Traction
Crutch Training
Axillary Crutch Proper Fit
 Establish appropriate height of crutches.
o Stand as straight as possible and allow arms to hang relaxed at side.
o Crutch tips should be placed 6 inches diagonally in front of and to side of toes.
o Allow about one inch or two to three finger widths between the axilla and top
of crutch
o Adjust legs / mechanism to appropriate height
 Establish the Hand Grip Height
o Standing as straight as possible with hands relaxed at sides the wrist should be
level with the grips.
o A 20 to 30 degree bend at the elbow should be present with correct hand grip
height.
o The crutch is adjusted so the elbow is flexed no more than 30 degrees when
the palm is on the handle
Types of Weight Bearing
 Non-Weight Bearing Status:
o Do not apply any weight through involved leg.
 Touch Down Weight Bearing:
o Allow only the ball of the foot to touch the floor for balance purposes.
 Partial Weight Bearing:
o Allow a maximum of 50% body weight (or determined amount about medical
doctor) to be applied to the involved leg.
 Weight Bearing As Tolerated (WBAT):
o Allow as much weight as tolerated through the involved leg.
Gait Crutch Training Instructions
 Place crutches under arms and press them against the body.
 Weight should be through the hands, not under the arms.
 Place the crutches forward 6 to 12 inches, then swing the involved (bad) leg to or
through the crutches.
Types of Gait with Crutches
 Two-point gait:
o One crutch and opposite extremity move together followed by the opposite
crutch and extremity.
 Three-point gait:
o Both crutches and involved (bad) leg are advanced together, then uninvolved
(good) leg.
 Four-point gait:
o A slow gait pattern in which one crutch is advanced forward and placed on the
floor, followed by advancement of the opposite leg; then the remaining crutch
is advanced forward followed by the opposite remaining leg.
Orthopedic Skills:
Crutch Training, CPM, Stump Wrapping, Traction
 Swing-to gait:
o Both crutches are advanced forward together; weight is shifted onto hands for
support and the legs are then swung forward to meet the crutches.
 Swing-through gait:
o Both crutches are advanced forward together; weight is shifted onto the hands
for support and the legs which are swung forward beyond the point of crutch
placement.
Stair Crutch Training Instructions
 Going up stairs, lead up with Uninvolved (good) leg and follow with involved (bad)
leg and the crutches.
 Going downstairs, lead with crutches and involved (bad) leg consecutively, then
follow with uninvolved (good) leg.
 GOOD goes UP and BAD goes down ***
 GOOD goes UP / BAD goes DOWN ***
Transfer Crutch Training Instruction: “Nose- Toes”
 Sit to Stand Transfer
o Slide forward to front of chair.
o Place crutches on involved (bad)side.
o Bend uninvolved (good) leg, positioning it behind involved (bad) leg.
o Press up from the chair using the crutch hand grips and the chair arm rest.
 Stand to Sit
o Stand with uninvolved (good) leg touching the chair.
o Bring crutches to involved (bad) side and extend involved (bad) leg out in
front.
o Lower body into chair using crutches hand grips and the chair arm rest.
Orthopedic Skills:
Crutch Training, CPM, Stump Wrapping, Traction
Continuous Passive Motion (CPM)
CPM
 Definition: A constant passive movement of a joint in a specific plane through a
controlled range of motion.
 Passive ROM: Movement of a joint gradually and slowly without the use of the
patient’s muscles.
CPM Indications
 Total Knee Replacement
 ACL reconstruction
 Manipulation under anesthesia
 Meniscus repair
 Prosthetic replacement




Prolonged joint immobilization
Shoulder arthroplasty
Rotator Cuff Repair
Reconstructive surgery of bone,
cartilage, tendons, and ligament
CPM Benefits**
 Reduce post-operative pain and swelling
 Prevent joint stiffness; Maintain and Increase ROM
 Prevent intra-articular adhesions (scar tissue)
 Prevent extra-articular contracture (shortening of a muscle or tendon)
Basic Installation and Operation
 All CPM devices will vary depending on type and brand; Most Commonly Used is
the Knee CPM.
 Set Up Instructions must be followed in order to ensure proper anatomical alignment
of joint or extremity.
 Installation
o Place the CPM device on a flat, solid surface.
o Attach Soft Goods to the carriage of the CPM by using the instructions
provided with the device.
o Plug the three prong plug into a properly grounded outlet.
 Set Up Operation of a Knee CPM
o RESET the unit to clear of prior settings.
o Measure the patient from hip joint (greater trochanter) to knee in centimeters.
o Adjust the femur component on the CPM to match hip to knee measurement.
o Carefully place the CPM under the affected limb.
o Align the knee joint with the hinge point on the device **
o Adjust the footplate using the footplate locking knobs so the patient’s footrest
comfortably; patient kit (Soft Goods) should support the leg from knee to foot.
o Secure the limb in the carriage frame by fastening the strap.
Orthopedic Skills:
Crutch Training, CPM, Stump Wrapping, Traction
Stump Wrapping: AKA/ BKA
Important Teaching
• ROM exercises for prevention of flexion contractures, particularly in hip and knee.
• Trapeze** and overhead frame aid in strengthening the arms and allow the patient to
move independently in bed; Firm mattress** is essential to prevent contractures with
leg amputation.
• Move patient slowly to prevent muscle spasms
• Assist the patient to prone** position every 3 to 4 hrs. for 20 to 30minutes periods if
tolerated and not contraindicated
AKA Wrap: Steps to Follow
 Two 4 or 6 inch ace wraps sewn together or attached with Velcro or tape will be
required to wrap the stump**
 Start wrap at front of leg and take around the back and hip to waist level. Bring wrap
around the body to secure in place.
 Go across the outside upper part of the leg and then wrap down and across to the
lower inside of the stump to start the figure 8 pattern.
 Keep repeating figure 8** pattern until the leg is covered. Each layer of wrap should
overlap the layer before.
 Remember to apply less pressure with the wrap as you move up the leg. Secure ace
wrap using tape or Velcro
 For wrapping to be effective, reapply the bandages every 4 to 6 hrs. or more often if
they become loose
BKA Wrapping: Steps to Follow
 Two 4 to 6 inch ace wraps sewn together or attached with Velcro or tape will be
required to wrap stump.
 Start above the knee to anchor the wrap around your leg. Make a circle with the wrap
around your leg.
 Take the wrap to the back of the leg and then across and down the stump. This starts
the figure 8 pattern.
 Bring the wrap around to the front of the stump, then across and up towards the knee.
 Wrap around the back of knee and then down across the stump.
 Wrap around the base of the stump and then up and across towards the knee. Put more
pressure at the bottom of the stump with the wrap than at the top so blood flow is not
limited to the stump.
 Continue until stump is covered and make sure the edges overlap. Secure the end of
the wrap with Velcro or tape.
Orthopedic Skills:
Crutch Training, CPM, Stump Wrapping, Traction
TRACTION
Definition and Purpose
• Traction is the use of a pulling force to treat muscle and skeleton disorders.
• Traction is used to treat fractures, dislocations, and long duration muscle spasms, and
to prevent or correct deformities.
• The exertion of a pulling force, as that applied to a fractured bone or dislocated joint
to maintain proper position and facilitate healing.
Principles of Effective Traction
 Whenever traction is applied, a counterforce must be applied; frequently the patient’s
body weight and positioning in bed supply the counterforce
 Traction must be continuous to reduce and immobilize fractures
 Skeletal traction is never interrupted
 Weights are not removed unless intermittent traction is prescribed
 Any factor that reduces pull must be eliminated
 Ropes must be unobstructed, and weights must hang freely
 Knots or the footplate must not touch the foot of the bed
 All traction needs to be applied in two directions. The lines of pull are “vectors of
force.” The result of the pulling force is between the two lines of the vectors of force.
Types of Traction
 Skin Traction:
o Limited amount of weight used to prevent injury to skin (5 to 10 pounds)
o Performed in a hospital bed normally
o Dunlop’s traction -used in children with certain upper arm fractures.
o Pelvic traction- applied to the lower spine, with belt around waist.
 Bucks traction
o Used to treat knee injuries other than fractures
o The purpose is to stabilize the knee and reduce muscle spasm.
 Skeletal Traction
o Used when more pulling force is needed than can be withstood by skin
traction; Uses weights of 15 to 30 pounds.
o Requires placement of pins or screws into the bone so that the weight is
applied directly to the bone.
Action Alert
• Patients in traction weights usually are not removed without a prescription
• They should not be lifted manually or allowed to rest on the floor
• They should be freely hanging at all times
• Inspect skin at least every 8 hrs. for signs of irritation or inflammation
Examples of Skeletal Traction
 Cervical traction-used for fractures of the neck vertebrae.
 Overhead arm traction-used for certain types of upper arm fractures.
 Tibia pin traction-used for some fractures of the femur, hip, or pelvis.