How do I clean external fixator pin sites?

Clean each pin site daily with antibacterial soap (Dial or Hibiclens) and water during a shower. Gently roll each pin with clean fingers to remove crusts, rinse thoroughly, and pat dry with clean towel or sterile gauze, then apply fresh sterile gauze wrap if instructed by your surgeon.

How often should pin care be performed?

Daily pin site care is required. Most patients shower and clean pins once per day; patients with heavy drainage or early signs of infection may be instructed to clean twice daily.

What are signs of pin site infection?

Increased redness spreading more than 1 cm from the pin, new or worsening pain, thick yellow/green drainage, foul odor, or fever >101°F (38.3°C) are signs of possible infection requiring immediate contact with the Paley Institute.

Should I use hydrogen peroxide or alcohol on pin sites?

No. Hydrogen peroxide, alcohol, Betadine, and antibiotic ointments can damage healthy tissue and are not recommended by the Paley Institute protocol.

Can I swim or take a bath with an external fixator?

No swimming in pools, hot tubs, lakes, or oceans until the fixator is removed. Showers are permitted; baths are not allowed because of infection risk.

Do I need to wrap the pins with gauze every day?

Most Paley Institute patients go without daily wrapping after the first 2–3 weeks if there is minimal drainage. Your surgeon will tell you when you can leave pins open to air.

When should I call the doctor about my pins?

Call immediately if you have fever >101°F, severe increasing pain not relieved by medication, loosening of pins, large amount of bleeding, or any signs of deep infection listed above.

External Fixator Pin Care: Expert Tips for Cleaning, Infection Prevention & Maintenance

Pin Care

Cleaning and Care

You should wash the pin sites with soap and water while in the shower. You may usean antibacterial soap, such as Dial, to wash the pin sites and fixator.
After showering or soaking and while the skin is still moist, use a sterile cotton tip applicator (Q-Tip) or tweezers to brush or pull off any scabs or crust surrounding the pin sites. Do NOT insert the cotton swab below the level of the skin into the pin site. After showering, please follow your clinical instructions to:
After showering, please follow your clinical instructions to: re-wrap each pin site with sterile gauze or the Acticoat octagons or leave open to air as long as the pin sites are not draining

Pools, Ocean and Baths

Signs and Symptoms of Pin Infection

Tenderness around the pin site that was not previously tender. This is often the first sign.
Redness in the same general area (compared to other areas). Do not confuse redness from infection with the red or purple color from scar formation.
Warmth in the same general area (compared to other areas).
Swelling of the area may be hard or fluid-like.
Drainage from the area. Characteristics may vary such as consistency, color, and smell.
Remember that amber or tea-colored drainage is normal in small amounts.
Odor is a sign that the infection has progressed.
Temperature (fever) taken by mouth or under the arm of 101 degrees or greater. Do not take temperature within two hours of physical therapy as it may be elevated from exercising. It is possible to have a pin-site infection without an accompanying fever.

When to contact medical staff

It is typical for the pin sites to be pink in appearance or have a slight red discoloration to the skin. It is also typical for them to drain a clear to yellow or blood-tinged fluid on occasion.
If you feel you are developing signs or symptoms to suggest an infection (pain, redness, warmth, tenderness, drainage, that is yellow or white in appearance, fever, etc.) please contact the office immediately at (561) 844-5255 and ask to speak to one of the medical assistants. Please take a picture of the area of concern and email it to the medical assistants and one of the clinicians will determine if antibiotics need to be started. You may be discharged home with antibiotics in the event you develop an infection. Please fill this antibiotic if you have been instructed to do so by our office.
If it is after business hours, please take a picture of the area of concern and email it to the on-call person that the call service will connect you to, (561) 844-5255. In the email, please provide the name of the patient, date of birth, pharmacy name and number, weight, and any known allergies.

Healthy Pin Sites

These pin sites are healthy and uninfected. This is what pin sites should look like.

Questionable Pin Sites

These pin sites show possible signs of infection. They should be checked by a physician or PA.

Infected Pin Sites

These pin sites are confirmed infected. Treatment should be sought immediately.

It is important to keep in mind that pin site infections are a part of wearing an external fixator. It is not unusual for a patient to have at least one pin site infection. It is not necessarily a reflection on you or your care of the fixator. The important part of pin site infections is that they are easily treatable and managed when spotted early and addressed swiftly.