Treatment of Splinters
Remove superficial splinters immediately by incising the skin over the length of the splinter and lifting it out with forceps, as reactive materials like wood and thorns should be extracted before inflammation or infection develops. 1
Initial Assessment and Timing
- Immediate removal is critical for wood, thorns, spines, and vegetative material to prevent inflammatory reactions and infection 1
- Superficial horizontal splinters are typically visible on inspection or easily palpated 1
- Deeper or elusive splinters may require imaging modalities (such as ultrasound with waterbath technique) for precise localization before removal 1, 2
Removal Technique by Location
Superficial Horizontal Splinters
- Expose the entire splinter by incising the skin along its long axis, then grasp and lift it out with forceps 1
- This technique provides complete visualization and prevents fragmentation during removal 1
Subungual (Under the Nail) Splinters
- Cut out a V-shaped piece of the nail with the point of the V positioned at the proximal tip of the splinter 1
- Grasp the splinter carefully and remove it, taking particular care not to push it deeper into the nail bed 1
When to Refer
Refer deeper splinters to a specialist when they are located near critical structures including nerves, tendons, blood vessels, or vital organs 1
Common Pitfalls to Avoid
- Do not attempt home removal of large, deep, or difficult-to-visualize splinters that may require imaging guidance 1
- Avoid pushing subungual splinters further into the nail bed during extraction attempts 1
- Do not delay removal of reactive organic materials, as they provoke more intense inflammatory responses than inert materials 1