Traction and Cast Care on the NCLEX

Traction and cast questions are pure safety rules. Break one rule in the stem, and that is the answer.

Skin vs skeletal traction

Skin traction (Buck's): pulls through boots or straps on intact skin. Light weights, about 5-10 lb. Short-term, classically pre-op for hip fracture to reduce spasm. Assess the skin under the device. Skeletal traction: pins or wires through bone. Heavier weights, roughly 15-30 lb. Long-term alignment. Priority: pin-site care and watching for infection (redness, purulent drainage, fever).

Traction rules

Weights hang freely at all times. Never resting on the floor, the bed, or a chair. Never remove or lift weights without an order. Releasing traction lets muscle spasm displace the fracture. Ropes stay in the pulley grooves, knots away from pulleys. Maintain body alignment; the patient's body provides countertraction, so keep them from sliding down the bed.

Cast neurovascular checks

Check distal to the cast: color, warmth, capillary refill under 3 seconds, pulses, sensation, movement, and compare to the other limb. Increasing pain, numbness, or tightness: think compartment syndrome and call the provider. Elevate a fresh casted limb to reduce swelling, but never above the heart if compartment syndrome is suspected.

Hot spots and other cast red flags

A warm area (hot spot) on the cast, foul odor, or drainage through the cast suggests infection or tissue breakdown underneath. Report it. Handle a wet plaster cast with palms, not fingertips (fingertips dent it and create pressure points). Nothing goes inside the cast to scratch. Itching: blow cool air from a hairdryer.

Frequently asked

Buck's traction weight is resting on the bed frame. First action?

Reposition so the weight hangs freely. This restores the prescribed pull and needs no order.

Serous drainage at a skeletal pin site?

A small amount can be expected. Purulent drainage, spreading redness, or fever is infection: report it.

Quick check

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