What is the treatment for a retained splinter hand injury?

Treatment of Retained Splinter Hand Injury

Retained splinters in the hand should be removed immediately to prevent inflammation or infection, using appropriate localization techniques and surgical extraction when necessary. 1

Initial Assessment and Localization

• Visualization and Palpation: First attempt to identify the splinter through direct inspection and palpation 1
• Imaging:
  • Standard radiographs should be obtained first, but many splinters (especially wood, thorns, and vegetative material) are radiolucent 1, 2
  • High-frequency ultrasound is the preferred imaging modality for radiolucent foreign bodies when standard radiographs are negative 2, 3
  • Ultrasound has proven reliable and efficient for detecting and localizing wooden splinters, minimizing surgical dissection and operating room time 3

Removal Techniques

For Superficial Splinters:

• Horizontal superficial splinters: Incise the skin over the long axis of the splinter and lift it out with forceps 1
• Subungual splinters: Cut a V-shaped piece of the nail with the point at the proximal tip of the splinter, then grasp and remove the splinter 1
• Caution: Take care not to push the splinter further into tissues during removal attempts 1

For Deeper Splinters:

• Deeper splinters near important structures (nerves, tendons, blood vessels) require referral for surgical removal 1
• Surgical exploration should be performed with adequate anesthesia and proper visualization 2
• Incomplete removal can lead to late infections, as demonstrated in cases where wooden splinters caused midpalmar abscesses months after initial injury 2

Post-Removal Care

• Clean the wound thoroughly after splinter removal
• Apply appropriate dressing to prevent contamination of any open wounds 4
• For larger wounds or after surgical extraction:
  • Immobilize with a rigid splint that adequately protects the injured area 4, 5
  • Ensure proper padding to prevent pressure injuries 4
  • Secure splint with tape or wrap that is snug but not constrictive 4
  • Leave fingertip exposed for circulatory checks 4

Pain Management and Activity Restriction

• Over-the-counter pain medications (acetaminophen or NSAIDs) for pain control 4
• Cold application with ice-water mixture in a plastic bag (with thin towel barrier) for 20 minutes to reduce pain and swelling 4
• Activity restriction for 4-6 weeks depending on injury severity 4

Follow-up Care

• Follow-up within 1-2 weeks with orthopedics or hand surgery if the wound was significant or required surgical exploration 4
• Perform active motion exercises of uninvolved joints to prevent stiffness 4, 6
• Monitor for signs of infection (increasing pain, redness, swelling, warmth, purulent drainage)
• Seek immediate medical attention if the finger appears blue, purple, or pale (indicating compromised blood flow) 4

Prevention of Complications

• Control edema to prevent complications 6
• Proper wound care is essential 6
• Avoid forceful exercise during healing 6
• Ensure appropriate splinting techniques to avoid unnecessary morbidity 5, 6

Retained splinters, especially organic materials like wood, can cause significant inflammation and infection if not removed promptly and completely. Using the appropriate diagnostic and removal techniques is crucial to prevent complications and ensure optimal hand function.