👤 By the CinnaRN Clinical Content Team🕐 Updated 2026-08-23🏷️ Basic Care & Comfort🔖 Free to read, print, and share
Also known as: pins and weights · bone traction · leg traction · pulling weights
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Use this quick-reference guide to spot, treat, and prevent Skeletal Traction on the NCLEX. Keep it handy during review and on exam day!
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📒 The 1-minute cheat sheet
✅ Do
Weights hang freely, off floor
Ropes in pulley grooves, aligned
Maintain countertraction (body align)
📌 Never
Never lift/remove weights
Don't let weights rest on floor
📌 Pins
Pin care per protocol, watch infection
Report ↑ drainage, redness, odor
🩺 Watch
Neurovascular checks q hr early
Skin breakdown, DVT from immobility
📚 Skeletal Traction — full study notes
The cheat sheet above is your quick recall card. These notes go deeper — what it is, what to do first, what must be reported, and what to teach.
Skeletal traction applies a continuous pulling force directly to a bone through pins, wires, or screws to align and immobilize fractures, often before surgery. Unlike skin traction, it uses heavier weights and is maintained continuously. The nurse must protect pin sites from infection and ensure the traction setup stays effective and uninterrupted.
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Key points
Understand these first
Weights must hang freely and never rest on the floor or be removed without a provider's order.
Skeletal traction is continuous; skin (Buck's) traction can be intermittent and uses lighter weights.
Pin sites are a direct portal for infection and a leading source of osteomyelitis.
Ropes must move freely over pulleys and be aligned with the long axis of the bone.
Maintaining proper body alignment is essential for the traction to work correctly.
Prolonged immobility raises the risk of pressure injury, DVT, pneumonia, and constipation.
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Nursing priorities
What to do, in order
Ensure weights hang freely off the floor and never lift or remove them without an order.
Provide pin site care with aseptic technique and assess for signs of infection.
Perform regular neurovascular checks distal to the fracture.
Maintain proper body alignment and keep ropes and pulleys functioning freely.
Prevent immobility complications with skin care, repositioning of unaffected areas, and DVT prophylaxis.
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Red flags — report now
Escalate immediately
Purulent drainage, increasing redness, or fever at a pin site signals infection and must be reported.
Loss of distal pulse, numbness, or increasing pain indicates neurovascular compromise; act immediately.
Never remove the traction weights or let them rest on the bed or floor, as this disrupts alignment.
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Labs & values
Numbers to know
WBC: 5,000 to 10,000/mm3 (elevated with pin site infection)
Hemoglobin: 12 to 18 g/dL (monitor for fracture-related blood loss)
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Patient teaching
What patients must know
Do not adjust or lift the weights or change your position in a way that misaligns the traction.
Report any drainage, redness, or increased pain at the pin sites or new numbness or tingling.
Perform deep breathing and ankle exercises in the unaffected leg to prevent complications.
❓ Skeletal Traction: NCLEX FAQs
What are the priority nursing interventions for Skeletal Traction?
Ensure weights hang freely off the floor and never lift or remove them without an order. Provide pin site care with aseptic technique and assess for signs of infection. Perform regular neurovascular checks distal to the fracture. Maintain proper body alignment and keep ropes and pulleys functioning freely.
What are the warning signs of Skeletal Traction a nurse must report?
Purulent drainage, increasing redness, or fever at a pin site signals infection and must be reported. Loss of distal pulse, numbness, or increasing pain indicates neurovascular compromise; act immediately. Never remove the traction weights or let them rest on the bed or floor, as this disrupts alignment.
What do I need to know about Skeletal Traction for the NCLEX?
Weights must hang freely and never rest on the floor or be removed without a provider's order. Skeletal traction is continuous; skin (Buck's) traction can be intermittent and uses lighter weights. Pin sites are a direct portal for infection and a leading source of osteomyelitis. Ropes must move freely over pulleys and be aligned with the long axis of the bone.
What patient teaching is important for Skeletal Traction?
Do not adjust or lift the weights or change your position in a way that misaligns the traction. Report any drainage, redness, or increased pain at the pin sites or new numbness or tingling. Perform deep breathing and ankle exercises in the unaffected leg to prevent complications.
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Quick Tip
Weights must hang freely and never rest on the floor or be removed without a provider's order.