Recommendations for Pin Care: Avoiding Infection
      by Dr. Nancy Romer (patient and psychologist)

      Keeping your pin sites infection-free is probably the most important job you have during your recovery. If you do a great job keeping yourself infection-free (and if your body cooperates with you), you'll have an easier and less painful time of it.

      The first thing to be aware of is that each pin site is its own open wound and must never share germs with another pin site. This means never use an applicator (6-inch Q-tip), paper towel, or any other cleaning implement from one pin site to the next.

      This is what I do and it's worked pretty well so far:

      1) The shower
      Take a daily shower and make sure that you have a hose with which to wash yourself. I use an 80-inch hose purchased from Home Depot attached to a showerhead. We purchased a "diverter" which, with the flick of a switch, will funnel water either into the new showerhead with the 80" hose or through the original showerhead. Use your favorite soap on the rest of your body, but only use Dial Anti-Bacterial soap in a pump bottle on your pin sites. Point the shower hose directly on the pin sites (front and back of the frame), then pump Dial soap directly on to each pin site. Do not touch the pin site with the hose or the pump bottle; just the soap and water. Thoroughly hose off the soap with the clean water. That will get rid of most of the dead skin and thoroughly clean the pin sites. Make sure all the soap residue is removed by the shower hose. Cleaning your pin sites should be the last thing you do in the shower so that any other residue from the rest of your shower that might have fallen on the pin sites will have been cleaned. I use a clean washcloth to dry the area around the pin sites and the frame, but never touch the pin sites themselves. Let them air dry.

      2) Cleaning with hydrogen peroxide
      Do this on a bed or in a place where you can comfortably sit with your leg up for a half hour. Have all of your pin care materials and implements in a container next to you. Mix equal amounts of hydrogen peroxide and sterile water in a clean paper cup (use a different paper cup each day). Use sterile 6" cotton-tipped applicators (long one-sided Q-tips). You'll probably use about 15 packs each cleaning. Take three or four of the packages, strip them of the paper packaging and dip them into the mixture of peroxide and sterile water. Take one applicator and use it to clean one pin site. Clean all around the pin site and throw the applicator away. You will probably need two or three applicators for each pin site to do a good job. Don't forget to clean the full length of the pin itself. Any excess dead skin or other debris should be removed. NEVER USE THE SAME APPLICATOR ON MORE THAN ONE PIN SITE OR YOU WILL SPREAD POTENTIAL INFECTION. Repeat this with each of the pin sites. Note: I have used sterilized toothbrushes (a different brush for each pin site) for particularly hard-to-get-to or infected pin sites. Make sure to buy only soft toothbrushes and to brush the pin site gently but firmly enough to clean it thoroughly. Don't forget to sterilize each toothbrush before each cleaning in boiling water and alcohol. Dip each sterilized toothbrush into the peroxide and sterile water mixture only once. When you are finished cleaning each of the pins, take the left over mixture and pour it directly onto the pin sites. Dry each pin site with a sterile applicator -- never use the same applicator for drying more than one pin site. Use a hair dryer with a low temperature to further dry the pin sites. Make sure the hair dryer does not touch the pin sites. Dry the pin sites front and back.

      3) Anti-biotic ointment
      Use triple anti-biotic pain relief ointment (Neosporin, or better yet, a generic copy that each pharmacy chain has) to keep your pin sites bacteria-free yet moist. Dry, cracked skin around the pin sites can be very painful. Apply about 1/4 of an inch of the ointment with a sterile applicator on to each pin site. Again, only use one applicator on one pin site. Make sure that the whole pin site is covered by the ointment.

      4) Xeroform Petrolatum Dressing
      This is another product that can help you keep your pin sites clean and moist. The gauze dressing comes in a long, folded rectangle. Purchase a scissors specifically meant to cut gauze which can be purchased at a pharmacy specializing in surgical supplies for about $7 (regular scissors will not work). Also purchase two tweezers. Sterilize the scissors and tweezers each day by boiling in water for 10 minutes and then cleaning them with rubbing alcohol. Cut out about a square inch of gauze from the rectangle. Hold it with the sterilized tweezers, not your fingers. Make a diagonal cut 2/3s of the way into the gauze square. Using the two tweezers, place the gauze on your pin site with the diagonal cut around the pin. Do not touch the pin site directly with the tweezers.

      5) Kerlix Bandage (This only applies to monolateral frames, not the circular frames)
      At last, you are ready to finish off the job. Use a fresh Kerlix bandage each day. Wrap the Kerlix bandage around the outside of the pins until you've used the entire Kerlix bandage. Make sure the bandage is close to and covering the Xeroform gauze. This bandage is further protection to keep your pin sites clean.

      Note for swimmers: If you swim in chlorinated water, either use the shower in the locker room (plus Dial soap) for your daily cleaning and then continue with the rest of the pin care. If you can't do the full pin care as described above, pour some hydrogen peroxide and sterile water mixture on the pin sites and cover with a fresh Kerlix bandage; do the rest of the pin care at home.

      Building Your Immune System
      While pin care is the most important factor preventing infection, how your body responds to infection is important too. I take lots of vitamins (a multi-vitamin, an additional 1500 mg of C and Kyolic garlic extract) to boost my immune system. I also drink a cup of fresh-squeezed orange juice daily. Don't forget to take at least 1500 mg of calcium each day to help support bone growth. I also take a combination of arginine and ornithine as well as symphytum officinale to foster bone growth.

      Where to Purchase Less Expensive Pin Care Materials

      Kerlix Bandages
      Life-Assist, Inc
      $1.98 a bandage

      Cotton Tipped Applicators
      $3.00 a box for 200 applicators

      Xeroform Petrolatum Gauze Dressing
      21st Century Medical
      box of 5 x 9" strips for $95.00 (50 strips)
      box of 1 x 8" strips for $63.00 (50 strips)

      Symphytum Officinale (Boiron)
      (Bone Trauma Promotes Healing of Fractures)
      877-876-8247 $4.31 each

      Neosporin (with Pain Reliever) costs about $8.00.
      The generic from Rite-Aid or CVS or other chains is about $3.65.