[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Medical–surgical nursing](https://durgical.com/en/nursing/areas/med-surg/) › Traction and external fixators: alignment, weights hanging free and pin-site care

# Traction and external fixators: alignment, weights hanging free and pin-site care

- Procedure

In traction the weights hang free, the body stays aligned and the pin sites are watched for infection; the same pin checks apply to an external fixator.

Updated Nov 13, 2026

## Key points

- Skeletal traction is continuous: weights hang free, off the floor and the bed, and are not lifted or removed without an order.
- Ropes run in the pulley grooves, with no knots touching a pulley and no bedclothes on the cord.
- Keep the patient centred and aligned: if the patient slides down the bed, the counter-pull is lost.
- Pin sites: watch for increasing redness, warmth, pain, swelling, pus, or a pin that feels loose.
- No pin-care method has proven best; follow the institutional protocol and teach the patient before discharge.

## What it is

Traction pulls on a limb with weights through ropes and pulleys, either through the skin (skin traction) or through a pin or wire in the bone (skeletal traction). An external fixator holds the bone with pins joined to a frame outside the skin. For traction to work the pull must be constant in size and direction, so the nurse checks that the weights hang free, the ropes run in the pulleys and the patient stays aligned against the counter-pull. With pins in the bone, the main risk is pin-site infection, which can loosen the pins and spread to the bone. The nurse also prevents the complications of lying in bed and checks the limb's circulation and nerves.

## Indications

- Skin or skeletal traction before or after surgery, to align a fracture or ease muscle spasm, as ordered.
- External fixator after an open fracture, a severe soft-tissue injury or a complex fracture.
- Daily checks of the traction system and of each pin site.
- Teaching pin-site care and warning signs to the patient and family before discharge.

## Contraindications and precautions

- Check the order: type of traction, weight, angle and alignment; changes are made only on the order.
- Skin traction is not applied over damaged skin or on a skin allergy to the material.
- When moving the patient, keep the pull steady and do not let the weights drop or swing.
- Leave the end of the limb uncovered so it can be observed, and cover it separately when it is cold.
- Immobility raises the risk of pressure injury, chest infection and constipation.

## Equipment

- The traction frame, ropes, pulleys and weights set up as ordered.
- Pressure-relieving mattress and heel protection.
- Gloves, sterile gauze and the cleaning solution and dressing set by the pin-care protocol.
- Neurovascular observation chart.
- A foot support, if ordered, to prevent foot drop.

## Step by step (and why)

- Each shift, check that weights hang free, ropes sit in the pulleys, cords are not frayed and no knot touches a pulley — anything that rubs changes the pull.
- Confirm that the weight and the alignment match the order, and record them — the pull must stay constant in size and direction.
- Keep the patient centred and aligned; reposition if the patient has slid down or the foot touches the bed end — the body weight provides the counter-pull.
- Check colour, warmth, refill, pulses, sensation and movement of the limb per protocol — traction and fixators can compress vessels and nerves.
- Inspect each pin site for redness, warmth, swelling, drainage, crusts and pain, and for a loose pin — early infection is treated before it reaches bone.
- Clean and dress the pin sites with the method and frequency of the institutional protocol, using clean hands and gloves — this limits cross-infection.
- Inspect and relieve pressure on the sacrum, heels and under any skin-traction boot or strap — pressure injuries develop fast in bed-bound patients.
- Encourage deep breathing, exercise of the free limbs, self-care, fibre and the bedpan at usual times — this prevents bed-rest complications.
- Before discharge with a fixator, teach pin care and the warning signs, and check that the patient can do it — most healing happens at home.

## Complications

- Pin-site infection, pin loosening and, if untreated, bone infection.
- Loss of alignment if the pull is interrupted or the fixation fails.
- Nerve or blood-vessel compression in the limb.
- Pressure injuries, especially on the heels and sacrum.
- Complications of bed rest: chest infection, constipation and loss of muscle and joint movement.

## Next step: when to call for help

- Report a pin site with spreading redness, pus, a foul smell, increasing pain, fever, or a pin that has moved or feels loose.
- Report at once a limb that is pale, cold, numb or weak, or pain that rises despite pain relief.
- Report weights or ropes that cannot be set right, or a change in the limb's position.
- Report redness or broken skin on the heels, sacrum or under any strap or boot.
- At home: the patient calls the team for fever, pus or spreading redness at a pin, or a loose pin.

## Test yourself

Think of the answer, then tap the question to see it.

## Why must the weights of skeletal traction hang free?

If a weight rests on the floor or the bed, the pull on the bone stops or changes, and the fracture can lose its alignment.

## Where does the counter-pull in traction usually come from?

From the patient's own body weight, so the patient must stay centred and must not slide down the bed.

## Which signs at a pin site suggest infection?

Increasing redness, warmth, swelling, pain and drainage, pus, or a pin that feels loose.

## Is there one proven best method of pin-site care?

No. A Cochrane review found no method clearly better; follow the institutional protocol and teach the patient before discharge.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/nursing/traction-and-external-fixators-alignment-weights-hanging-free-and-pin-site-care/)

## Connections

## Related 4

- [The patient with a fracture: neurovascular checks, elevation, pain and complications](https://durgical.com/en/nursing/the-patient-with-a-fracture-neurovascular-checks-elevation-pain-and-complication/)
- [Complications of immobility and how to prevent them](https://durgical.com/en/nursing/complications-of-immobility-and-how-to-prevent-them/)
- [Mechanical prevention of venous thromboembolism: stockings and intermittent compression](https://durgical.com/en/nursing/mechanical-prevention-of-venous-thromboembolism-stockings-and-intermittent-compr/)
- [Patient positions: Fowler, supine, lateral, prone and others](https://durgical.com/en/nursing/patient-positions-fowler-supine-lateral-prone-and-others/)

## Related conditions 3

- [Femoral shaft fracture](https://durgical.com/en/conditions/femoral-shaft-fracture/)
- [Open fracture](https://durgical.com/en/conditions/open-fracture/)
- [Pelvic fracture](https://durgical.com/en/conditions/pelvic-fracture/)

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: [Lethaby A, Temple J, Santy-Tomlinson J. Pin site care for preventing infections associated with external bone fixators and pins. Cochrane Database Syst Rev 2013, Issue 12](https://pmc.ncbi.nlm.nih.gov/articles/PMC12042071/) (Cochrane Database of Systematic Reviews (PubMed Central, open access), 2013); [Kofman KE, Buckley T, McGrouther DA. Complications of transcutaneous metal devices. Eur J Plast Surg 35(9):673-682](https://pmc.ncbi.nlm.nih.gov/articles/PMC3419834/) (European Journal of Plastic Surgery (PubMed Central, open access), 2011); [Neves TA, Camargo CA, Comarú MN. Alguns aspectos que fundamentam a assistência de enfermagem a pacientes em tração. Rev Bras Enferm 29(2):56-63](https://www.scielo.br/j/reben/a/8fv7hcbfsr5WHc49vBfm5Qm/?lang=pt) (Revista Brasileira de Enfermagem (SciELO, open access), 1976).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/nursing/traction-and-external-fixators-alignment-weights-hanging-free-and-pin-site-care/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/traction-and-external-fixators-alignment-weights-hanging-free-and-pin-site-care/