Fracture care is a core skill for every registered nurse (RN nurse), especially in orthopedic and med-surg units. Knowing how to manage casts, traction, and neurovascular checks is essential for safe patient outcomes — and is guaranteed to appear on NCLEX exams. Let’s break it down in a simple, quick-reference style perfect for your nursing bundle or study notes.
🦴 What is a Fracture?
A fracture is a break or disruption in bone continuity, often caused by trauma, falls, or underlying conditions like osteoporosis. The priority for any nurse is to stabilize the injury, relieve pain, and prevent complications.
🩹 Cast Care Basics
Casts are the most common way to immobilize a fracture while it heals. Here’s what every RN nurse should know:
✅ Types of Casts
- Plaster casts (less expensive, mold well)
- Fiberglass casts (lighter, more water-resistant)
✅ Nursing Priorities with Casts
- Keep the cast dry
- Support it on pillows to reduce swelling
- Perform neurovascular checks every 1–2 hours initially
- Watch for odor, drainage, or skin irritation
- Teach patients not to stick objects inside the cast
✅ Cast Complications
- Compartment syndrome (medical emergency!)
- Skin breakdown
- Pressure ulcers
NCLEX tip: if a patient complains of severe pain unrelieved by medication, think compartment syndrome.
🪢 Traction Nursing Care
Traction helps align fractured bones by applying a pulling force. It can be:
- Skin traction (Buck’s traction)
- Skeletal traction (pins, wires, screws into bone)
✅ Nursing Responsibilities
- Maintain the correct weight — never remove weights without a provider order
- Check ropes, pulleys, and alignment every shift
- Skin assessments under straps
- Frequent neurovascular checks
- Prevent foot drop with foot supports
NCLEX pearl: traction weights should hang freely, never rest on the floor.
🔎 Neurovascular Checks Made Easy
Whether your patient has a cast or traction, neurovascular checks are your best friend:
Think 6 Ps:
- Pain
- Pallor
- Pulses
- Paresthesia (tingling/numbness)
- Paralysis
- Poikilothermia (cool temperature)
✅ Compare bilaterally
✅ Document thoroughly
✅ Report any sudden changes to the provider right away
🧩 Nursing Bundle Cheat Sheet
Add these to your nursing bundle:
✅ Cast care steps
✅ Traction equipment checklist
✅ 6 Ps neurovascular assessment guide
✅ Compartment syndrome red flag sheet
Perfect for med-surg or orthopedic NCLEX practice!
🩺 Teaching Patients with Fractures
As an RN nurse, teaching patients is just as vital:
- Signs of infection (fever, foul smell)
- When to return to the clinic (increased pain, numbness, color changes)
- How to safely use crutches or walkers
- Cast or traction precautions
- Importance of follow-up X-rays
⚠️ Complications to Watch For
Nurses should be alert for:
- Fat embolism syndrome (shortness of breath, confusion, petechiae)
- Deep vein thrombosis (DVT)
- Pressure ulcers from immobility
- Loss of muscle strength
Early detection = better outcomes and fewer long-term problems.
📝 Quick Takeaways
💡 Casts = protect skin + monitor circulation
💡 Traction = align bones + keep weights free-hanging
💡 Neurovascular checks = 6 Ps every time
💡 Report unrelieved pain fast to prevent compartment syndrome