Reference — Musculoskeletal
Cast & Traction Care Reference
Casts and traction both immobilize bone — and both can injure the patient wearing them. The nursing job is the same for each: protect skin, protect perfusion, keep the mechanics correct, and teach the patient what they must never do.
Educational use only. Traction setup, weight amounts, and pin-site care solutions are provider-ordered and facility-specific — never adjust a traction prescription independently. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Cast Care Essentials
While the cast dries
Plaster takes 24–72 hours to cure (fiberglass under an hour). Handle a wet plaster cast with open palms — fingertips dent it and the dent presses on skin. Leave it uncovered to air-dry on cloth-covered pillows, repositioning regularly; no heat lamps or dryers.
The first 24–48 hours
Elevate above heart level and apply cold per protocol to limit swelling. Neurovascular checks on schedule — the freshly casted limb is the classic compartment syndrome setup.
Surveillance findings
Report a “hot spot” (warm area on the cast surface), foul odor, or new drainage staining — each suggests infection or pressure necrosis under the cast. Mark drainage edges with time and date to trend. New burning or pressure pain at one spot inside the cast is a pressure injury forming.
What the patient must never do
Nothing goes down the cast — no hangers, pencils, or powder. Itching is managed with a cool hairdryer blown under the edge, oral antihistamines per orders, and distraction. Keep the cast dry; petal rough edges with moleskin or tape to protect skin.
Skin vs Skeletal Traction
| Feature | Skin Traction (e.g., Buck’s) | Skeletal Traction |
|---|---|---|
| Attachment | Boot, tape, or foam on intact skin | Pin or wire through bone |
| Typical weight | Light — commonly 5–10 lb | Heavier — commonly 15–30 lb per orders |
| Purpose | Temporary comfort/alignment (e.g., pre-op hip fracture) | Longer-term reduction and alignment of unstable fractures |
| May the nurse remove it? | Per orders/protocol for skin checks | Never — weights stay on continuously unless the provider orders otherwise |
| Signature risk | Skin breakdown under the boot/tape | Pin-site infection → osteomyelitis |
Traction Mechanics — The Standing Rules
Weights hang freely at all times — never resting on the floor, the bed frame, or a chair, and never lifted or removed to reposition the patient (skin traction only per orders). Ropes ride in the pulley grooves with knots away from pulleys; the line of pull stays aligned with the long axis of the bone. Maintain counter-traction: the patient’s body provides it, so keep them positioned up in bed, not slumped against the footboard.
Check the whole apparatus every shift and after any repositioning: rope integrity, pulley function, weight clearance, and the patient’s alignment. The traction prescription belongs to the provider; the traction inspection belongs to the nurse.
Pin-Site Care
Inspect pin sites every shift for redness, warmth, purulent drainage, and pin loosening. Serous drainage and crusting are common; spreading erythema, increasing pain, and purulence are not — report them. Clean per facility protocol (commonly chlorhexidine-based solutions with sterile applicators, one applicator per pin), and do not routinely remove crusts unless protocol directs it. Fever plus deep bone pain at a pin site raises the osteomyelitis question.
NCLEX Pearls
- ✦Weights hang free and are never removed from skeletal traction — lifting weights to “make the patient comfortable” is the classic wrong answer.
- ✦Handle wet plaster with palms, not fingertips; let it air-dry uncovered.
- ✦Hot spot, foul odor, or one-point burning pain under a cast = infection or pressure necrosis — notify the provider.
- ✦Buck’s traction is skin traction used pre-operatively for hip fractures — light weights, skin checks, no pins.
- ✦Neurovascular checks follow every cast application and traction adjustment — automatically, not on request.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Academy of Orthopaedic Surgeons (AAOS) · National Association of Orthopaedic Nurses (NAON). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →