OET letter for a fracture patient: cast care, weight-bearing and mobility
In an OET Nursing letter about a patient with a fracture, say which bone was broken, how it was treated (cast, splint or surgery) and the date, then give the instructions the reader must follow: weight-bearing status, cast or wound checks, pain relief, mobility aids and the follow-up appointment. Write weight-bearing and cast warnings in full, plain sentences because they are safety points the reader acts on.
What makes fracture letters different
Fracture cases look simple, but the notes often mix several things: how the injury happened, X-ray findings, the treatment, pain scores, physiotherapy sessions, a mobility assessment and the home situation. The reader, often a community nurse, GP, physiotherapist, care home or family member, needs a short summary and clear instructions they can follow safely.
Three details are easy to lose and costly to get wrong:
- Weight-bearing status: how much weight the patient may put on the limb.
- Cast, splint or wound care: what to check and what to avoid.
- Follow-up: when and where the fracture will be reviewed.
Questions to answer before you write
- Which bone, which side, and how was it treated?
- What can the patient do now (walk, transfer, wash, dress) and with what aid?
- What must the reader check or avoid?
- What pain relief is the patient taking?
- Is there a falls risk or a home problem behind the injury?
- What is the follow-up plan?
For the general method, see how to select case notes.
What to include and what to leave out
| Usually include | Usually leave out |
|---|---|
| Fracture site, side and date | Full X-ray report |
| Treatment: cast, splint, surgery | Details of the anaesthetic |
| Weight-bearing instructions in full | Each physiotherapy session |
| Cast or wound checks from the notes | Normal observations |
| Mobility aid and level of help needed | Every pain score |
| Pain relief on discharge | Medicines given once on the ward |
| Falls risk or home hazards relevant to the plan | Unrelated history and hobbies |
| Fracture clinic or follow-up date | Ward routines |
Turning orthopaedic notes into sentences
| Notes | Letter sentence |
|---|---|
| # L distal radius, POP applied 8/3 | "She fractured her left wrist on 8 March and has a plaster cast." |
| R ankle ORIF 10/3, NWB 6/52 | "She had surgery to fix a fracture of her right ankle on 10 March and must not put weight on that leg for six weeks." |
| Mob c crutches, S/B stairs | "She walks with crutches and needs someone standing by on the stairs." |
| Elevate, check CSM fingers | "Her arm should be kept raised, and her fingers should be checked for colour, warmth, feeling and movement." |
| Cast clinic 22/3 for check X-ray | "She will attend the fracture clinic on 22 March for a check X-ray." |
| Tripped on loose rug in hallway | "She tripped on a loose rug at home." |
The time periods in these examples are invented. In the test, copy the exact periods and instructions in the case notes. For more on abbreviations, see OET writing abbreviations.
Writing weight-bearing instructions clearly
Weight-bearing status is a safety instruction. Give it a sentence of its own and make the limb and the limit unambiguous.
| Unclear | Clear |
|---|---|
| "She is NWB." | "She must not put any weight on her right leg." |
| "Partial weight bearing as tolerated." | "She may put some weight on her left leg, using a frame, as her pain allows." |
| "Mobilising." | "He walks short distances with a stick and supervision." |
If the patient also has a cast, put the cast checks next to the weight-bearing instruction so the reader finds all the limb care in one place.
Worked example (invented case)
Case summary (invented): Mrs Helen Castellano, 74, widowed, lives alone in a two-storey house. Tripped on loose hallway rug 9 March. Fractured right ankle, surgery 10 March. Below-knee cast. Must not put weight on right leg for six weeks. Walks short distances with a frame; needs someone standing by on stairs; sleeping downstairs for now. Check toes for colour, warmth, swelling and numbness; keep cast dry; leg raised when sitting. Paracetamol regularly, oxycodone if needed; constipated on day 2, started laxative. Daughter visits weekends. Fracture clinic 24 March. Former teacher; knits. Discharge 14 March. Task: write to the community nurse.
Selection decisions:
- In: fracture and surgery, cast and checks, weight-bearing, frame and stairs, sleeping downstairs, pain relief and laxative, rug as a falls hazard, lives alone with weekend support, clinic date.
- Out: teacher, knitting, anaesthetic, daily pain scores.
Sample letter body:
Dear Community Nurse,
Re: Mrs Helen Castellano, aged 74
I am writing to refer Mrs Castellano, who is being discharged home today after surgery for a fractured right ankle, for ongoing care and monitoring.
Mrs Castellano fractured her ankle on 9 March after tripping on a loose rug at home, and the fracture was surgically repaired the following day. She has a below-knee cast, which must be kept dry, and her leg should be raised when she is sitting. Her toes should be checked for any change in colour or warmth, swelling or numbness.
She must not put any weight on her right leg for six weeks. She walks short distances with a frame and needs someone standing by on the stairs, so she will sleep downstairs for now. Her pain is controlled with regular paracetamol and oxycodone when required. She became constipated on the ward and has started a laxative.
Mrs Castellano lives alone, and her daughter visits at weekends. She will attend the fracture clinic on 24 March.
I would be grateful if you could check her cast and circulation, monitor her pain and bowels, and assess her home for falls hazards, including the hallway rug. Please do not hesitate to contact me if you require any further information.
Yours sincerely,
The weight-bearing instruction has its own clear sentence, the cast checks sit together, and the request names each check, including the falls hazard raised earlier.
Practise timed letters at /writing/, or check a letter you have written to see which case notes you included, missed or added unnecessarily.
Mistakes to avoid
- Weight-bearing abbreviations. NWB, PWB and FWB must be written out.
- Telling the whole fall story. One sentence, and only if it affects the plan.
- Scattering limb care. Keep the cast, elevation and circulation checks together.
- Leaving out the follow-up date. The reader needs it to plan.
- Ignoring the cause. If a home hazard caused the fall, the reader can act on it.
Related: falls risk and mobility letters, post-operative discharge letters and pain management in letters.
Sources
This guide is medEmu's writing advice, not official OET guidance or clinical advice; all patients, medicines, time periods and plans are invented for practice and must not be used to guide care. The network used for this run could not reach oet.com, so no OET test facts are stated beyond the criterion names. For OET's official Writing information, see oet.com.