Splinter Under Nail: Removal Recommended
A subungual splinter should be removed promptly rather than left to heal on its own, as reactive foreign bodies like wood and vegetative material can lead to inflammation and infection if not extracted immediately. 1
Removal Technique
The standard approach for a subungual splinter involves cutting out a V-shaped piece of the nail, with the point of the V positioned at the proximal tip of the splinter 1. The splinter is then grasped with forceps and carefully removed, taking particular care not to push it deeper into the nail bed 1.
Key Technical Points:
- Complete visualization is essential - the entire splinter should be exposed before attempting removal 1
- Immediate removal is preferred - wood, thorns, and vegetative material should be extracted before inflammation develops 1
- Pain control matters - local anesthesia should be administered before the procedure 2
Post-Removal Care
After splinter removal, implement the following wound care protocol:
- Daily antiseptic soaks with dilute vinegar (50:50 dilution) or 2% povidone-iodine for 10-15 minutes twice daily 3
- Monitor for infection signs including increased pain, redness, swelling, or purulent drainage 4, 3
- Apply mid to high-potency topical steroid ointment to the nail folds twice daily if inflammation develops 3, 2
When to Obtain Cultures and Antibiotics
If infection develops (evidenced by pus, increased warmth, or purulent drainage), obtain bacterial cultures and initiate oral antibiotics with coverage against Staphylococcus aureus and gram-positive organisms 4, 3. Recommended oral antibiotics include first-generation cephalosporins, amoxicillin-clavulanate, clindamycin, or doxycycline 4.
Important Caveats
Do not leave reactive foreign bodies in place - unlike inert materials, wood and organic splinters will trigger inflammatory responses that complicate healing 1. Deeper splinters near important structures (nerves, tendons, blood vessels) should be referred for specialist removal rather than attempted at home 1.
Reassess the wound at 2 weeks to ensure proper healing 3. Persistent pain or drainage beyond 2-4 weeks may require additional intervention 3.