Looking after your frame – pin site care

The external fixator frame that holds the pins in place needs careful care, especially to keep them clean. This page from Great Ormond Street Hospital (GOSH) explains what you need to do and what action you need to take if problems develop.

• The nurse will clean the pin sites.
• Parent(s) will watch.
• You may have Entonox® so you are relaxed and comfortable.

• The nurse will help you and/or your parent(s) to clean the pin sites so you can do it at home.

• You and/or your parent(s) will clean the pin sites while the nurse watches what you are doing until you feel confident doing the cleaning on your own.
• This may take several times to get all the steps right.

• You and/or your parent(s) will need to be assessed as competent in pin site cleaning before you go home. 
• After discharge, you should clean the pin sites once a week unless any problems happen, when you should increase cleaning as described below. 
• You will need to come back to GOSH every two weeks for a check-up appointment during the lengthening period. Once lengthening has stopped you will come back to clinic every four to six weeks.

We will teach you how to clean pin sites before you go home. We have included brand names for products used in pin site cleaning but in many cases, alternatives will be available. Including a specific brand does not mean that we are recommending it as the only option.

• One plastic tray to be used only for pin site cleaning 
• Prontosan® solution
• 1-4 Packs of sterile gauze
• Allevyne® non-adhesive (non-stick) foam pads
• Scissors used only for pin site care
• Plastic bag for used dressings and gauze
• Dermol® 500 emollient
• Prontosan® gel X – if pin site(s) is infected

1. Wash your hands with warm soapy water and dry with kitchen towel.
2. Wash the plastic tray in warm soapy water and dry with kitchen paper.
3. Place the packet of gauze clear side down in tray. Open the gauze packet by pulling the white packaging away from you. Keep the clear packaging and gauze in the tray – do not touch. 
4. Pour some Prontosan® solution directly on to the gauze sheets in the clear packaging to soak.
5. Unwrap the Allevyne® foam dressings by placing the packet of dressing in the tray and by pulling the top layer of the packaging away from you. Place in the tray on the packaging.
6. Using the scissors cut the foam into 6 strips and each strip into 5 squares. This should give you 30 small squares of foam dressing. Cut a slit in each of the squares from one edge so they look like a pair of trousers.
7. Wash your hands with warm soapy water and dry with kitchen towel.
8. Starting at the top of the frame, pull the bungs up and remove all the old dressings and put in the plastic bag.
9. After you have removed all the old dressings, wash your hands with warm soapy water and dry with kitchen towel. 
10. Remove one sheet of gauze, open it up and wrap it around the pin site and leave it to soak. Start at the top of the frame and work your way down. Do this for each of the pins. 
11. Starting at the top of the frame wipe the gauze in a back and forth motion up the pin. 
12. Repeat as necessary for each pin using a fresh piece of gauze. 
13. If a pin site is infected, apply a thin layer of the Prontosan® gel X around the pin, using a fresh piece of gauze.
14. Put one piece of Allevyne® foam dressing, white side down, around each pin using the slit you cut earlier.
15. Apply Dermol® 500 to the limb to moisturise.
16. Dispose of plastic bag containing the old dressings and used gauze in your household rubbish.
17. Wash your hands and the tray with warm soapy water and dry with kitchen towel again.

What does the pin site look like?

There are three ways we describe how the pin site may look, calm, irritated and infected. Below is how each one is identified there may be variations of these please call the CNS team if you are unsure,

• It may not hurt or only hurt a bit
• It may not be red or only a bit red and does not spread
• It may not be oozing or only a little bit
• It is not swollen
• You are otherwise well
• It may be a bit crusty with scabs around the pins.

You should:

• Have a shower and clean the pin sites once a week – you will need to clean your pins straight away after each shower.
• We will tell you in clinic if the pin sites no longer need cleaning.

This may affect every pin site or just one or two

• It may be uncomfortable with mild to moderate pain
• It may be red but does not spread
• The skin is not stretched or hot
• Swelling is only around the pin site, not anywhere else
• Skin moves freely around the pin
• Pin site is sore when you have been moving
• Skin is itchy, dry and flaky

You should:

• Have a shower and clean the pin sites twice a week – clean your pins straight away after each shower.
• Try not to knock off the scabs when you are cleaning the pin sites – these are a good sign they are healing. 
• Contact the CNS team and inform them you are concerned and have started the irritated cleaning process. We may ask you to send us a photo.

Most infections are caused by bacteria so antibiotics work well to treat it.

• Comes on suddenly and gets worse quickly with throbbing and stinging, also affecting joints
• You cannot put any weight on the limb and it does not get better when you rest the limb
• The pain does not get better when you take pain relief
• The pin site looks red and ‘angry’, feels hot, and has a definite border
• An increase in oozing or the ooze looks or smells different
• Swelling around the pin site and surrounding skin that may be severe
• You might feel generally unwell, with a temperature, trouble sleeping and pain

You should:

• Shower and clean pin sites every 2 to 3 days. You will need to clean your pins straight away after each shower.
• When cleaning the infected pin, follow all the steps stated above from step 11, ensuring you leave the gauze soaked in Prontosan® solution wrapped around the pin for 15 minutes.
• Put a thin layer of Prontosan® Gel X around the pin using a piece of sterile gauze then apply the foam dressing.
• You might have to clean the affected pin site(s) more often depending on how much the area is oozing. 
• Try not to knock off the scabs when you are cleaning the pin sites – these are a good sign they are healing. 
• Contact the CNS team and inform them that you are concerned and have started the infected cleaning process. We may need you to send us a photo and you may need to start oral antibiotics.

We will supply you with an initial supply but you will need to request a prescription from your family doctor (GP) after that.

You will need

• Allevyn® foam dressings size 20cm x 20cm/8in x 8in.
• Prontosan® solution 100 ml bottle
• Packs of sterile gauze
• Prontosan® gel X
• Dermol® 500
• Tramadol 

We will send you home with a letter for you to take to your GP explaining what is needed.

• Do not fiddle with the pins or pick off scabs or skin flakes.
• If you shower more than once a week you will need to clean your pins after each shower.
• Keep the limb well moisturised – use the Dermol® 500 for this.
• Start showering once the main operation site has healed – this is usually within two weeks or so. 
• You can go swimming once the main operation site has healed but not if you have any signs of pin site/wound infection. 
• If pin sites get wet, you should clean them straight away, that is, after showering or swimming.
• Have two towels, one for your body and a separate one for the affected limb. Wash the towels on a 60 degree cycle.