An orthopedic nurse (or ortho nurse) is a registered nurse who cares for patients with conditions of the bones, joints, muscles and spine, from fractures and sports injuries to hip and knee replacements and spinal surgery. Orthopedic nurses manage pain, get patients moving again after surgery, watch for serious complications like compartment syndrome and blood clots, care for casts, traction and surgical hardware and teach patients how to protect their new joints at home.
This guide covers what orthopedic nurses do, where they work, neurovascular assessments, compartment syndrome, types of traction (including Buck's traction), hip precautions, CPM machines, log rolling, fat embolism syndrome, how to become an orthopedic nurse, ONC certification, salary and how to celebrate during Orthopaedic Nurses Week.
In this guide
- What is an orthopedic nurse?
- What does an orthopedic nurse do?
- Where do orthopedic nurses work?
- The neurovascular assessment
- Compartment syndrome and the 6 Ps
- Types of traction and Buck's traction
- Hip and knee replacement care
- What is a log roll?
- Other orthopedic complications
- How to become an orthopedic nurse
- ONC certification
- How much do orthopedic nurses make?
- What is it like to be an orthopedic nurse?
- A short history of orthopedic nursing
- When is Orthopaedic Nurses Week?
- Gifts for orthopedic nurses
- Ortho nurse humor
- Frequently asked questions
What is an orthopedic nurse?
Orthopedics (also spelled orthopaedics) is the branch of medicine focused on the musculoskeletal system: bones, joints, ligaments, tendons, muscles and the spine. Orthopedic nurses care for patients of every age, from babies with hip dysplasia and kids with broken arms to athletes with torn ligaments and older adults with hip fractures and arthritis.
Common orthopedic patients include people recovering from:
- Total hip and knee replacements
- Hip fractures and other broken bones
- Spinal surgery, including spinal fusions
- Sports injuries and ligament repairs, such as ACL surgery
- Shoulder surgery and rotator cuff repairs
- Trauma with multiple fractures
- Bone infections and amputations
What does an orthopedic nurse do?
- Post-operative care: monitoring vital signs, surgical sites, drains and bleeding after orthopedic surgery
- Pain management: balancing pain control with getting patients up and moving, often using a combination of medications, ice and nerve blocks
- Neurovascular checks: assessing circulation, movement and sensation in injured or operated limbs
- Mobility: getting patients out of bed, often the day of surgery, working closely with physical and occupational therapists
- Casts, splints, braces and traction: applying, checking and teaching patients how to care for them
- Preventing complications: blood clots, infections, falls, pressure injuries and constipation
- Pin and hardware care: caring for external fixators and pin sites
- Patient education: teaching hip precautions, walker and crutch use, wound care and home safety
- Discharge planning: helping patients go home or to rehab safely
Where do orthopedic nurses work?
- Inpatient orthopedic and spine units in hospitals
- Operating rooms and PACUs that specialize in orthopedic surgery (see our OR nurse and PACU nurse guides)
- Ambulatory surgery centers, where many joint replacements are now done as same-day surgery
- Orthopedic clinics and sports medicine offices
- Trauma centers
- Rehabilitation hospitals and skilled nursing facilities
- Home health (see our home health nurse guide)
- Joint replacement programs as nurse navigators
The neurovascular assessment
A neurovascular assessment checks blood flow and nerve function in an injured or operated limb. It is one of the most important skills in orthopedic nursing, because changes can signal emergencies like compartment syndrome or damage to blood vessels and nerves. Nurses always compare the affected limb with the other side.
| What is checked | What nurses look for |
|---|---|
| Color | Pale, bluish or dusky skin compared with the other side |
| Temperature | A limb that feels cool or cold |
| Capillary refill | How quickly color returns after pressing a nail bed; slow refill is a concern |
| Pulses | Weak or missing pulses below the injury |
| Sensation | Numbness, tingling or "pins and needles" |
| Movement | Trouble wiggling fingers or toes |
| Pain and swelling | Pain that is getting worse or swelling that is increasing |
Many nurses remember the basics as CMS: circulation, motion and sensation.
Compartment syndrome and the 6 Ps
Compartment syndrome happens when swelling or bleeding builds up pressure inside a closed muscle compartment, most often in the lower leg or forearm. The pressure can cut off blood flow to muscles and nerves. Acute compartment syndrome is a surgical emergency, usually treated with a fasciotomy (an incision to relieve the pressure). It can happen after fractures, crush injuries or a cast or dressing that is too tight.
Nursing students learn the warning signs as the 6 Ps:
- Pain out of proportion to the injury, especially pain when the muscles are passively stretched (often the earliest sign)
- Pressure or a tense, hard feeling in the limb (some lists use poikilothermia, a cool limb)
- Paresthesia: numbness or tingling
- Pallor: pale skin
- Paralysis: weakness or inability to move (a late sign)
- Pulselessness: a very late sign, so a normal pulse does not rule out compartment syndrome
If compartment syndrome is suspected, nurses notify the provider immediately and follow their facility's protocol, which often includes loosening tight dressings and keeping the limb at heart level rather than elevated.
This guide is educational. Anyone with severe or worsening pain, numbness or trouble moving a limb after an injury, surgery or cast should seek medical care right away.
Types of traction and Buck's traction
Traction uses a pulling force, usually from weights, to align bones, reduce muscle spasms or keep a fracture stable. It is used less often today than in the past, because surgery can fix most fractures quickly, but orthopedic nurses still care for patients in traction.
| Type | How it works |
|---|---|
| Skin traction | Straps, boots or wraps attached to the skin; used for short-term, lighter pulling |
| Skeletal traction | Pins or wires placed directly into the bone; allows heavier, longer traction |
| Cervical traction | Tongs or a halo device attached to the skull to stabilize the neck |
Buck's traction is a common type of skin traction for the leg. A foam boot or wrap is placed on the lower leg and attached by a rope and pulley to weights hanging off the foot of the bed. It is often used for a short time to reduce pain and muscle spasms from a hip fracture before surgery.
Nursing care for any traction includes keeping the weights hanging freely (not resting on the bed or floor), making sure ropes run smoothly over pulleys, never removing the weights unless ordered, keeping the patient's body aligned, doing regular neurovascular and skin checks and watching for pressure injuries.
Hip and knee replacement care
Total hip and knee replacements are among the most common surgeries orthopedic nurses care for. Many patients now go home the same day or the next day through enhanced recovery programs that focus on early walking, good pain control and teaching.
What are hip precautions?
Hip precautions are movement restrictions some patients follow after hip replacement to lower the risk of dislocating the new joint. They depend on the surgical approach. After a posterior approach, common precautions include:
- Do not bend the hip past 90 degrees (no low chairs or leaning far forward).
- Do not cross the legs.
- Do not turn the operated leg or toes inward.
After an anterior approach, precautions are often fewer or different, such as avoiding stepping far backward with the operated leg or turning it outward. Many surgeons now use fewer precautions than in the past, so patients should always follow their own surgeon's instructions. Tools like raised toilet seats, reachers and sock aids help patients follow precautions at home.
What is a CPM machine?
A CPM (continuous passive motion) machine slowly and gently bends and straightens a joint, most often the knee, without the patient using their muscles. It was once routine after total knee replacement. Today it is used less often, because early physical therapy and walking are emphasized, but some surgeons still order it for certain patients and procedures. Nurses help set the range of motion and speed as ordered and check the skin and positioning.
Preventing blood clots
Orthopedic surgery, especially hip and knee replacement and hip fracture surgery, raises the risk of deep vein thrombosis (DVT) and pulmonary embolism. Orthopedic nurses help prevent clots with early walking, leg exercises, compression devices and blood thinners as prescribed, and they teach patients the warning signs to report.
What is a log roll?
A log roll is a technique for turning a patient while keeping the head, neck and spine in a straight line, like rolling a log. It is used for patients with spinal injuries or after certain spinal surgeries. It usually takes two or more staff members, with one person holding the head and neck and coordinating the count, so the whole body turns as one unit.
Other orthopedic complications
- Fat embolism syndrome: a rare but serious complication, most often after fractures of long bones like the femur. Fat droplets enter the bloodstream, usually within 24 to 72 hours, causing a classic triad of breathing problems, confusion or other neurologic changes and a pinpoint rash (petechiae), often on the chest.
- Surgical site infections and infections around implants
- Hip dislocation after hip replacement
- Delirium, especially in older adults after hip fracture surgery (see our geriatric nurse guide)
- Pin site infections with external fixators
- Constipation from pain medications and reduced activity
- Pressure injuries from immobility, casts and braces
How to become an orthopedic nurse
- Earn a nursing degree (ADN or BSN) and pass the NCLEX-RN.
- Get clinical experience. Many hospitals hire new graduates onto orthopedic units. Med-surg experience is also great preparation. (See our med-surg nurse guide.)
- Get BLS certified, and ACLS if your unit requires it.
- Build ortho skills: neurovascular assessments, cast and traction care, safe patient handling and post-op pain management.
- Earn the ONC once you meet the experience requirements.
- Consider advancing to orthopedic nurse navigator, educator, manager or orthopedic nurse practitioner. (See our nurse practitioner guide.)
ONC certification
The ONC (Orthopaedic Nurse Certified) credential is offered by the Orthopaedic Nurses Certification Board (ONCB). Eligibility generally requires a current RN license, at least two years of experience as an RN and at least 1,000 hours of orthopedic nursing practice within the past three years. Check ONCB for current requirements.
ONCB also offers certifications for advanced practice orthopedic nurses, including the ONP-C for orthopaedic nurse practitioners. The National Association of Orthopaedic Nurses (NAON) is the main professional organization for the specialty.
How much do orthopedic nurses make?
The U.S. Bureau of Labor Statistics does not publish a separate salary for orthopedic nurses, because it groups them with all registered nurses. The median annual wage for registered nurses was $97,550 in May 2025, according to the BLS. Nurse practitioners, including orthopedic NPs, earned a BLS median of $132,300.
Orthopedic nurse pay depends on setting (hospital, surgery center or clinic), location, experience, certification, shift differentials and role. Clinic and surgery center jobs often offer weekday daytime hours.
What is it like to be an orthopedic nurse?
- Mostly happy endings: many ortho patients come in hurting and leave walking better than they have in years.
- Physically demanding: helping patients move, turn and walk is a big part of the job, so safe patient handling equipment matters.
- Teamwork: ortho nurses work closely with surgeons, physical therapists, occupational therapists and case managers.
- Fast turnover: joint replacement patients often go home in a day or two.
- A little noisy: between drills in the OR and CPM machines on the floor, ortho can sound like a workshop.
A short history of orthopedic nursing
- 1741: French physician Nicolas Andry coins the word "orthopaedia," from Greek words meaning "straight" and "child," reflecting the field's early focus on correcting deformities in children.
- Early 1900s: orthopedic hospitals open, and polio epidemics create a huge need for nurses skilled in bracing, positioning and rehabilitation.
- 1960s: modern total hip replacement is developed, eventually making joint replacement one of the most common surgeries in the world.
- 1980: the National Association of Orthopaedic Nurses (NAON) is formed.
- 1990: International Orthopaedic Nurses Day on October 30 begins with a proclamation presented in the U.S. Senate.
- Today: orthopedic nurses care for patients in hospitals, same-day surgery centers, clinics and homes.
When is Orthopaedic Nurses Week?
International Orthopaedic Nurses Day is celebrated every year on October 30, and NAON celebrates Orthopaedic Nurses Week during the week that includes it. In 2025, Orthopaedic Nurses Week ran October 27 to 31. Falling right before Halloween, it is the perfect excuse for skeleton-themed celebrations.
Ortho Nurses Week ideas
- Decorate the unit with skeletons and "bone-fide hero" signs.
- Bring in bone-shaped cookies and other Halloween treats.
- Invite former joint replacement patients to share thank-you notes.
- Sponsor ONC exam fees or NAON memberships.
- Recognize the physical and occupational therapists, techs and case managers who get patients home.
Gifts for orthopedic nurses
A throwback design for the bone and joint crew. Perfect for Ortho Nurses Week or any day off. $29.99
Shop now →
For the coffee that powers first-day-post-op walks and endless neuro checks. $15.99
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For ONC study notes, surgeon preferences or report sheets. $17.99
Shop now →Ortho nurse humor
- "We fix what you break." (Now a sticker.)
- "Setting bones and fixing frames." (Also a sticker.)
- "I have a skeleton crew. Literally."
- "Wiggle your toes for me. Great. Now again in an hour. And an hour after that."
- "Ortho nurses: humerus and totally bone-afide."
- "Day one after a new knee: 'I can't walk.' Day two: walking laps around the unit."
Frequently asked questions
What does an orthopedic nurse do?
Orthopedic nurses care for patients with bone, joint, muscle and spine conditions. They provide post-operative care, manage pain, perform neurovascular checks, get patients moving, care for casts and traction, prevent complications like blood clots and teach patients how to recover safely at home.
What are the 6 Ps of compartment syndrome?
The 6 Ps are pain (especially with passive stretch), pressure or poikilothermia, paresthesia, pallor, paralysis and pulselessness. Pain is often the earliest sign, while paralysis and pulselessness are late signs. Acute compartment syndrome is a surgical emergency.
What is Buck's traction?
Buck's traction is a type of skin traction for the leg. A boot or wrap on the lower leg is attached by a rope and pulley to hanging weights. It is often used briefly to reduce pain and muscle spasms from a hip fracture before surgery.
What are hip precautions?
Hip precautions are movement limits after hip replacement that lower the risk of dislocation. After a posterior approach, they often include not bending the hip past 90 degrees, not crossing the legs and not turning the leg inward. Patients should follow their own surgeon's instructions.
What is a CPM machine?
A CPM (continuous passive motion) machine slowly bends and straightens a joint, usually the knee, without the patient using their muscles. It is sometimes used after knee surgery, though early physical therapy is now emphasized more.
What is the ONC certification?
The ONC (Orthopaedic Nurse Certified) is the main orthopedic nursing certification, offered by the Orthopaedic Nurses Certification Board. It generally requires two years of RN experience and 1,000 hours of orthopedic nursing practice within the past three years.
How much do orthopedic nurses make?
BLS does not report orthopedic nurse pay separately. Registered nurses overall earned a median of $97,550 in May 2025. Pay varies by setting, location, experience, certification and role.
When is Orthopaedic Nurses Day?
International Orthopaedic Nurses Day is celebrated every year on October 30, and NAON celebrates Orthopaedic Nurses Week during the week that includes it.
Exploring other specialties? See our full guide to nurse specialties and the types of nurses.
Celebrate the ortho nurses in your life
For Orthopaedic Nurses Week, a new ONC or the nurse who got you walking again.
Shop the Orthopedic Collection →Sources
- U.S. Bureau of Labor Statistics, Occupational Outlook Handbook: Registered Nurses
- National Association of Orthopaedic Nurses, Orthopaedic Nurses Week
- Orthopaedic Nurses Certification Board (ONCB), ONC Certification Eligibility
- American Academy of Orthopaedic Surgeons, OrthoInfo: Total Hip and Knee Replacement
- National Association of Orthopaedic Nurses, Core Curriculum for Orthopaedic Nursing