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There continues to be a lack of knowledge in the overall management of pin site crusts for orthopaedic clinicians to make evidence-based decisions on their retention or removal. The goal of pin site care is to reduce, or where possible, prevent pin site infection. Understanding the role of pin site crusts in the management of the pin site and prevention of pin site infection is important. The aim of this systematic integrative review is to explore the effectiveness of pin site crusts as a biological dressing versus the removal of pin site crusts in pin site care and prevention of pin site infection. Three electronic databases were used to conduct a systematic search. The methodologies of five studies that met inclusion criteria were appraised using the Mixed Method appraisal Tool. Findings reveal that pin site crusts have similar properties to that of a dressing, as the crusts are able to act as a barrier between the insertion site of the pin and external environment, which can reduce infection. Additional high-quality evidence is required to solidify the effectiveness of pin site crusts as a biological dressing.