Looking after your pin sites

Pin site care information for patients with external fixators

If your treatment is to be a success it is essential that you keep your pin sites clean. If your pin sites become seriously infected your treatment may have to be stopped. At worst, a serious pin site infection can lead to ‘osteomyelitis’ (infection of the bone).

You must keep your pin sites clean

Most pin site infections are caused by the bacteria staphylococcus aureus. Staph-aureus live harmlessly on most people, but can cause infection when transferred to broken skin.

Good hand washing technique before pin site cleaning is essential.

There are various suggested ways of cleaning pin sites. There is little evidence to support one technique over another, however the method described here has been used at Sheffield Children’s Hospital consistently and is effective in minimising the risk of pin site infection.

How to clean your pin sites

Using a shower is an effective way of cleaning your pin sites. Shower as normal, but concentrate the spray on your pin sites for a time to help remove any leakage or crusts.

• If your pin sites are clean after showering, dry them using a hairdryer on a cool setting.
• If for any reason you are unable to shower (for example, because of plaster casts or doctors instructions) or you still have crusts on some pin sites then follow the instructions below.

Equipment:

• Hand washing facilities.
• Clean container for cooled boiled water.
• Cotton buds – they do not need to be sterile.
• Plastic or paper bag to discard used cotton buds following cleaning.
• Tie back any long hair, roll up long sleeves and remove watches or bracelets.
• Clean hands that have been washed well with soap and water.

Using cooled boiled water and cotton buds, wipe around each pin site. Methodically clean one pin site at a time. Clean in a circular motion around the pin site. With one cotton bud, start at a point on the pin site and wipe half way around in one direction. With a second cotton bud continue to clean the other half of the pin site continuing to wipe in the same direction (this helps prevent cross infection).

• You may need to use several buds in order to remove stubborn crusts. Alternating ‘wet’ and ‘dry’ cotton buds can help.
• Dry each pin site after cleaning with wet cotton buds.
• The fixator frame can be kept clean using a clean cloth or aseptic wipe.
• We advise leaving pin sites uncovered so they remain dry. Do not use any creams, as they make the pin site soggy and encourage infection.
• We may advise the use of ‘bolster dressings’. If required, you will be taught how to do these before being discharged from hospital.
• Occasionally, the skin may grow up a wire or pin. This is called ‘tenting’. If this happens, wash your hands and gently massage the skin around the affected pin site to free it. If necessary, massaging can be done several times a day.

Signs of an infected pin site

If a pin site becomes painful, red or discharges pus, then increase pin site cleaning to 2 or 3 times a day. If there is no improvement after 24 hours, contact your GP who will prescribe a course of oral antibiotics. They may take a ‘swab’ of the site. You can also contact the hospital on the numbers provided.

However, some pin sites may leak ‘serous’ fluid which is generally pale yellow and transparent. This is not infection but your body’s way of trying to heal. It can be dressed with gauze if it appears excessive.