External fixators include pins and wires placed by surgeons to stabilize fractures such as those involving the tibia. In critical care, external fixators are more commonly used to stabilize cervical spine fractures. Because halo fixators secure cervical alignment, these devices allow early mobilization and shortened stays. However, halo-fixator complications include cranial pin loosening, localized infection, and superficial pressure sores.1,2  Loosening of cranial pins for halo fixators with signs of local infection, fever, headaches, or seizures deserves rapid notification of the surgeon and neuroimaging.3  Likewise, any tracking (open area with skin pulled away from pins) or clicking noises necessitate prompt assessment by the surgeon for potential loosening of pins.

Although daily assessment of pin sites to monitor for complications is not debated, the approach to pin-site care to prevent infection is less clear-cut. A common method of site care involves using normal saline to clean around each...

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