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Patients with tracheostomies may not be commonly admitted to orthopaedic units. Since this is an infrequently seen therapy in this population, and because the potential complications carry very high risks, orthopaedic nurses may be unfamiliar or uncomfortable with the nursing care needs of these patients. This article reviews the indications for tracheostomy tube insertion and the resulting physiologic changes that occur. Nursing assessment and tracheostomy care is described along with detailed information on potential complications and the associated nursing interventions.