Partial weight-bearing is the most commonly given and least commonly followed instruction in fracture care. 'Twenty kilograms' means nothing to someone who has never stood on a set of scales while leaning on crutches, and asking them at follow-up whether they have been keeping to it produces a yes with no information in it.
So demonstrate it and have them demonstrate it back, before they leave. Bathroom scales in the clinic are enough: set the scales on the floor, have the patient load the operated limb until the reading matches the target, and let them feel what it is. Repeat it with the crutches they will actually use. Most patients are startled by how little weight it is.
Then give the instruction in terms they can check at home - the scales they own, or a specific description like 'enough to squash a crisp packet, not enough to break it'. And re-demonstrate at the first follow-up rather than asking, because adherence drifts upwards over the weeks as the leg feels better, which is precisely when the fixation is least able to take it.
- Demonstrate the target load on bathroom scales before discharge and have the patient reproduce it
- Repeat the demonstration with the actual crutches or frame the patient will use
- Give a checkable instruction for home, not a number in kilograms alone
- Re-demonstrate at the first follow-up rather than asking whether they have complied
- Recognise that drift upwards happens as pain settles - warn the patient that feeling better is not the signal to load more
Why it matters
The instruction everyone gives is one most patients have never been shown how to follow.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for orthopaedics, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free