Three groups of seven patients had external fixation of middiaphyseal tibial fractures using uncoated pins, uncoated bicylindrical pins, and hydroxyapatite coated bicylindrical pins, respectively. All fractures were fixed with six pins, and all fractures united. Median pin insertion torque was 0.6, 1.2, and 1.3 Nm in the three groups, respectively. Median extraction torque was 0.1, 0.1, and 2.1 Nm, respectively. Both types of stainless steel pins showed a lower extraction torque than insertion torque in all cases, whereas the mean extraction torque in the hydroxyapatite coated pins was unchanged. Seven of the 14 patients receiving uncoated pins had pin tract infection, compared with none of the patients receiving hydroxyapatite coated pins. Hydroxyapatite coating of external fixation pins increases stability and thereby reduces the risk for pin tract infection and mechanical failure of fracture fixation.