Percutaneous Pinning
Percutaneous pinning is a way to support unstable fractures (breaks). “Percutaneous”
means “through the skin.” When the patient is asleep, a surgeon will reduce (set) the
fracture. The doctor will insert pins to hold the fracture in position until the bone is healed.
The number of pins depends on the fracture location and severity. Occasionally a small
incision (cut) is needed to help with pinning. The pins or wires are positioned across the
fracture (Pictures 1 and 2).
Picture 1 Pinned humerus (elbow) fracture Picture 2 Pinned middle phalanx
(finger) fracture
Before the Surgery
This surgery is often done in an out-patient surgery location unless your child has been
admitted to the hospital. The child may not have any food or liquids (including mints,
candy or gum) after midnight the previous night. You will get a call the day or evening
before surgery to tell you what time to come and give you directions. It is important that
you come on time.
Continued on page 2.
HH-I-415 4/16 Copyright 2016, Nationwide Children's Hospital
Percutaneous Pinning Page 2 of 3
Before the Surgery, continued
Some patients are admitted to the hospital the night before surgery because the fracture is
too unstable. Once the surgery is completed, they will return to the hospital unit. The child
will often be discharged the day of surgery. You will be given thorough instructions.
After the Surgery
Your child will most likely have a splint, cast or bandage after surgery. It is very important
that these remain in place and not be removed at any time. It is also very important that the
splint, cast or bandage remain completely dry. This will help prevent skin issues or infection
at the pin sites.
Your child should elevate the arm above the level of the heart with the hand higher than
the elbow. If the fingers are not the injured part, your child will be asked to wiggle the
fingers often.
You may put an ice bag over the splint or cast at the area of injury for 1 to 2 days several
times a day for 20 minute intervals. You must be careful not to allow the ice to leak, causing
the area to become wet. You will be sent home with one or more ice bags.
All activities should be limited until the medical practitioner clears the child to return to play
and sports. The child may have a “collar and cuff” or sling for several weeks. You will get
information about this at the time of discharge. It is important that this be worn as
instructed. (See Helping Hand HH- IV-147, Collar and Cuff.)
Follow-up at the Clinic
Usually a child will need to return for a follow-up about 1 week after surgery. Often a
Nurse Practitioner or Physician Assistant will examine the splint, cast or bandage. Your
child will have x-rays to check the position of the fracture and pins.
After the first visit, your child will return in 2 to 4 weeks to have the splint, cast or bandages
removed. The medical staff will examine the pin site again, and repeat x-rays. If the bone is
healed enough, they will remove the pins in the clinic. If there is not enough healing, they
will put on a splint or cast for another 1 to 2 weeks.
Pin Removal
You may give your child ibuprofen (Motrin®) or acetaminophen (Tylenol®) before returning
to the clinic for pin removal. Parents may hold their child’s hand during the procedure.
An orthopedic tech or nurse will come in the room to help. Any remaining bandages will be
removed. A special tool is used to remove the pins as gently as possible. There may be a
tiny bit of blood. The staff will apply a bandage and hold pressure. Once all the pins are
removed, the staff will apply a bandage and wrap. Your child will get another splint or cast
if needed.
Percutaneous Pinning Page 3 of 3
At Home after the Pin Removal
If there is a splint, it may be removable. If it is, follow the staff’s instructions.
If there is no splint, leave the bandage on for 24 to 48 hours. After that time, the bandage
may be removed. The child may then have a bath. Wash the area with soap and water
unless you notice any drainage. If there is drainage, call the orthopedic clinic to get
instructions. Gently dry the area and apply a large bandage or sterile dressing. Do not
apply ointments, creams or lotions to the area until the pin sites are completely healed.
If instructed by staff, the child should begin moving the joint as soon as possible. You
may receive a sheet of exercises when your child is cleared for this kind of activity. These
exercises will help with stiffness and allow the joint to return to normal function. If there
is soreness, giving ibuprofen (Motrin®) or acetaminophen (Tylenol®) may help.
Some children may have one more return visit. They often do not need x-rays, but do need
a “range of motion” check. This is to see how well the joint is moving. Children rarely need
formal therapy. If it is needed, the staff will discuss that with you.
When to Call the Doctor
Contact the orthopedic clinic if:
there is redness, swelling, pus or drainage at the pin sites
there is numbness or tingling
your child cannot move the fingers
your child has continuous pain or an increase in pain
your child has a fever:
o temperature higher than 100 degrees Fahrenheit taken in the mouth (oral)
o temperature higher than 100.4 degrees Fahrenheit taken in the ear or rectum
o temperature higher than 99 degrees Fahrenheit taken in the armpit (axillary)
Clinic contact information:
Clinic hours are Monday through Friday, 8:00 am to 4:30 pm. Phone number is
(614) 722-5175. Ask for the nurse to discuss any symptoms.
Evenings, Weekends and Holidays phone (614) 722-2000. Ask for the Orthopedic
Resident on call to discuss any symptoms.
Be sure to contact the clinic if you cannot keep any follow-up appointments.
