The placement of pins in the lower extremity for the purpose of skeletal traction is a basic skill required by an orthopedic surgeon. These pins are primarily used for the management of fractures and dislocations. Although simple, the insertion and care of these pins can be accompanied by severe complications including damage to neurovascular structures, physeal injury, ligamentous insult, fracture, and infection. We review the techniques of pin insertion at the distal femur, proximal tibia, and calcaneus to provide a foundation for residents and attendings alike so that unnecessary complications may be avoided and proper placement ensured.
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