Metatarsal fx activity order?

systoly · Nov 7, 2011

Cause, type and location vary, as does the status of the pt. I think the fact that it was splinted might be the key here.

roser13, ASN, RN · Nov 7, 2011

As always, we cannot second-guess the treating physician. But I will say that there's a big difference between walking with a walker and bearing weight vs. walking with a walker while non-weight bearing. I can't tell from your post which order was given and perhaps that's the clue that you're missing.

Extended periods of rest can only bring on secondary issue with patients.

psu_213, BSN, RN · Nov 7, 2011

Hello,
I'm a nursing student and I had a patient who had a right metatarsal fx on 10/12/11. She had the fx on 10/9.
Her foot hadbeen dressed and splinted. Her activity order at first was bed rest, then it was changed to up with one assist.
I had her use the walker while I supported. Should she have been up and walking only 3 days after her fracture?

What was the entire activity order? Bedrest is pretty straight forward (although for certain individuals it could include BRP). Did the new order just say assist x1? Did it specify if any assistive devices should be used (walker, crutches, cane, etc.)? Did it mention the weightbearing status of the fractured foot? Use that as your guide and make sure you know the entire activity status.

Jenni811, RN · Nov 7, 2011

yes!!! They can be up walking post op day 1.

I work on a cardiac floor and our open heart patients, we want them up walking the day after surgery. They spend a day in ICU before coming to our floor, and sometimes in ICU they will even get them up! Patients NEED to move move move move move!

Usually physicians will order activity such as "Up 3x daily" or "up to chair 4x daily" or "bed rest with bathroom privileges." its really not that common someone is someone on STRICT bedrest like that.

psu_213, BSN, RN · Nov 7, 2011

yes!!! They can be up walking post op day 1.
I work on a cardiac floor and our open heart patients, we want them up walking the day after surgery. They spend a day in ICU before coming to our floor, and sometimes in ICU they will even get them up! Patients NEED to move move move move move!
Usually physicians will order activity such as "Up 3x daily" or "up to chair 4x daily" or "bed rest with bathroom privileges." its really not that common someone is someone on STRICT bedrest like that.

I think walking after open heart vs walking after a foot fx surg are two different things. I don't think the question is "is it good for a post op pt to walk?" The obvious answer is yes. The question is should someone with a recently broken foot walk and bear weight on that foot? I don't think it is quite as simple as having open heart pt's walk POD 1.

akulahawkRN, ADN, RN, EMT-P · Nov 7, 2011

It all depends upon the actual order, which metatarsal was Fx'd, what was done to repair... but I would expect that the patient would be on some kind of partial weight bearing on that foot. The foot is splinted and any remaining unfractured metatarsals can take the strain of being up. This will also give the metatarsal fractures time to model themselves for maximum strength from the get-go. If just one metatarsal was broken, I might expect FWB as tolerated... as long as there's appropriate splinting in place to prevent shifting of the bone ends.