Synopsis
Translate fracture or fixation stability into precise limb-specific loading and mobilisation instructions that patients and every rehabilitation professional can apply, review and safely progress.
- Weight-bearing status describes permitted load through each affected limb; mobilisation describes how the person transfers, stands, walks and uses aids within that permission.
- BOASt recommends only three terms: Non Weightbearing, Limited Weightbearing and Unrestricted Weightbearing; abandon touch, partial, proportional, permissive and progressive weightbearing labels.
- For Non or Limited Weightbearing, document the clinical reason, functional or distance restriction, duration, planned phases, walking aids and any brace or rehabilitation protocol.
- Do not quantify Limited Weightbearing as a percentage of body weight or kilograms of force; specify practical boundaries such as transfers only, indoor distance or no stairs.
- First mobilisation assessment checks observations, pain, cognition, orthostatic symptoms, wound, distal neurovascular status, strength, balance, home demands and ability to use the prescribed aid.
- Review inpatient status no later than every 72 hours, within 24 hours when it directly prevents discharge, and at every follow-up point.
- Early mobilisation is usually desirable after hip fracture and joint surgery when medically and surgically safe, but it must follow the exact fixation, soft-tissue and loading plan.
- Progression needs explicit criteria and ownership; the absence of a new instruction is not permission for patients or community teams to guess.
Key red flags
Pain that becomes severe or disproportionate during mobilisation, particularly with pain on passive stretch, requires urgent assessment for compartment syndrome or fixation failure.
A cool pale limb, absent pulse, delayed capillary refill, new motor loss or progressive numbness after surgery needs immediate neurovascular reassessment and escalation.
A new wound leak, expanding swelling, visible deformity or a sudden crack with loss of function requires loading to stop until the construct is reviewed.
Chest pain, syncope, unexplained tachycardia or hypoxia during therapy may represent PE, myocardial ischaemia or another acute medical event.
Dizziness with a blood-pressure fall, hypoglycaemia, oversedation or delirium can turn otherwise permitted weight bearing into an immediate falls risk.
A patient unable to understand or physically achieve restricted loading needs a revised construct, brace, aid or supervision plan rather than repeated blame for non-adherence.
Investigation priorities
Test transfers, gait, aid use, balance, symptoms and adherence to the exact loading prescription.
Management branches
Surgery, fracture treatment or musculoskeletal injury changes safe limb loading.
- Assign Non, Limited or Unrestricted Weightbearing separately to every affected limb.
- For Non or Limited status, document clinical justification, functional or distance limit, duration and planned progression phases.
- Record walking aids, brace settings, range restrictions, supervision and relevant tasks such as stairs or transfers.
- Copy the same instruction into operative, nursing, therapy, patient and discharge documents.