Objective To investigate the value of pain nursing based on root cause analysis combined with Roy’s adaptation model in hypertensive patients with traumatic fracture. Methods A total of 96 hypertensive patients with traumatic fracture who underwent surgical treatment in our hospital from September 2023 to September 2024 were enrolled and divided into control group and observation group using a random number table, with 48 patients in each group. The patients in the control group received conventional perioperative nursing, and those in the observation group received pain nursing combined with Roy’s adaptation model based on root cause analysis. The two groups were assessed in terms of postoperative pain, psychological state, sleep quality, and blood pressure. Results Comparison of numerical rating scale (NRS) at 12, 24, 48, and 72 hours after surgery showed that the observation group had a significantly lower NRS score than the control group at each time point (P <0.05). Compared with the control group, the observation group had significant reductions in the scores of Hospital Anxiety and Depression Scale and Pittsburgh Sleep Quality Index after intervention (P <0.05). Monitoring results for systolic blood pressure (SBP) and diastolic blood pressure (DBP) showed that the observation group had significantly lower SBP and DBP than the control group after intervention (P <0.05). Conclusion For hypertensive patients with traumatic fracture, pain nursing combined with Roy’s adaptation model based on root cause analysis can significantly alleviate postoperative pain, improve sleep quality and negative emotion, and reduce blood pressure.