Pin site infection is the most common complication of external fixation, a complex orthopaedic procedure used to stabilise fractures and correct limb deformity. The care of pin sites has long been debated among healthcare professionals. It is widely acknowledged that there is a lack of high quality research in this area. In 2010 a meeting with the aim of achieving consensus about pin site care took place, funded by the Royal College of Nursing Society of Orthopaedic and Trauma Nursing. The aim was for practitioners who care for pin sites on a regular basis in adult, paediatric, hospital and community environments around the UK to explore and debate current practice. This article reports the findings of this meeting and discusses the difficulties in creating guidance on this area of practice.