What is the recommended treatment for a splinter?

Splinter Removal: Evidence-Based Treatment Approach

For most superficial splinters, immediate removal using simple incision and forceps extraction is the recommended treatment, as reactive materials like wood should be removed before inflammation or infection develops. 1

Initial Assessment

Before attempting removal, evaluate the following key characteristics:

• Depth and location: Superficial horizontal splinters are generally visible or easily palpated, while deeper splinters may require imaging 1
• Material type: Wood, thorns, spines, and vegetative material are reactive and should be removed immediately before inflammation occurs 1
• Proximity to critical structures: Splinters near nerves, tendons, blood vessels, or vital organs require referral for specialist removal 1
• Signs of infection: Assess for increased redness, warmth, purulent discharge, or increasing pain 2

Removal Techniques by Location

Superficial Horizontal Splinters

The optimal technique involves complete exposure followed by extraction:

• Incise the skin over the entire length of the splinter's long axis 1
• Lift the splinter out completely using forceps 1
• Ensure the entire foreign body is removed, as retained fragments can cause ongoing inflammation 1

Subungual (Under Nail) Splinters

A V-shaped nail excision provides the best access:

• Cut a V-shaped piece of nail with the point at the proximal tip of the splinter 1
• Grasp and remove the splinter carefully 1
• Take particular care not to push the splinter further into the nail bed during extraction 1

Imaging for Elusive Splinters

When a splinter cannot be easily located or palpated:

• Ultrasound or MRI are the preferred initial imaging modalities for wooden foreign bodies, depending on chronicity and proximity to bone 3
• MRI is most sensitive for splinters soaked in tissue fluid for extended periods (>5 months) 3
• Ultrasound is most effective for smaller splinters (1-4mm) that are distant from bone and recently embedded 3
• CT and MRI are more sensitive than ultrasound for splinters located near bone 3
• MRI scanning perpendicular to the splinter's long axis is more sensitive than parallel imaging 3

Wound Care After Removal

Cleansing Approach

• Cover any wounds with a clean dressing to reduce contamination risk 4
• Avoid excessive or repeated antiseptic use, as this may adversely affect normal tissue repair and create a microenvironment similar to chronic wounds 5
• When antiseptics are used, apply them at proper concentrations and timing 5

Post-Removal Monitoring

• Monitor for signs of infection over the next 48-72 hours 2
• If infection develops, re-evaluate and consider antibiotics 2
• Consider early surgical consultation (within 24-48 hours) if moderate to severe infection with necrotic tissue develops 2

Critical Pitfalls to Avoid

Do not attempt removal in these situations without specialist referral:

• Deep splinters near important neurovascular structures 1
• Splinters adjacent to tendons or vital organs 1
• When the digit appears blue, purple, or pale (indicating compromised perfusion) - activate emergency services immediately 4

Technical errors to avoid:

• Pushing the splinter deeper during extraction attempts, particularly with subungual splinters 1
• Incomplete removal leaving reactive material that will cause ongoing inflammation 1
• Overtightening compression wraps, which can compromise circulation 4
• Excessive antiseptic use that may impair wound healing 5

When to Refer

Immediate referral is indicated for:

• Splinters that remain elusive despite imaging 1
• Deep splinters near critical anatomical structures 1
• Signs of compromised perfusion (color changes in the digit) 4
• Development of moderate to severe infection 2