At the entry point, make a stab incision through the skin with a pointed scalpel.
Insert a Steinmann, or preferably a Denham pin (a Denham pin has a short threaded section in the center to prevent side-to-side motion of the pin in the bone), mounted in the T-handle, manually at a point about 2 cm posterior to the tibial tuberosity.
If a femoral pin is preferred, enter the pin slightly proximal to the superior pole of the patella.
As the pin is felt to penetrate the far cortex, check that the exit will coincide with the area of local anesthetic infiltration. If not, inject additional local anesthetic. Once the point of the pin clearly declares its exit site, make a small stab incision in the overlying skin.
Once the pin is in place, ensure that there is no tension on the skin at the entry and exit points. If there is, then a small relieving incision may be necessary.