Splinters

Most splinters in fingers and toes can be removed at home unless they are deep, infected, or under the nail.

• Splinters are foreign bodies that are partially or fully embedded in the skin. Splinters usually are wood, but metal, glass, and plastic materials may be considered splinters.
• Sometimes splinters have to be removed by medical professionals, especially splinters that are deeply embedded or lodged under a fingernail or toenail.
• Most people with splinters are able to remove them without medical intervention.
  • Splinters are usually found when they penetrate the skin -- usually in the hand or foot. Almost always, even fully embedded foreign bodies have a unique sensation.
  • Splinters are full of germs. If splinters are not removed (or don't work their way out themselves), they may cause an infection.

• Handling an object may cause a small portion to dislodge as the person applies friction to that object (examples would be woodworking, metalworking, or falling and sliding on wooden floors).
• The protective thorns of plants may cause splinters to lodge in the skin while gardening.
• Butchers may end up with a small splinter of bone penetrating their skin.
• The foot is usually injured when a person steps on a foreign body or slides forward (some examples would be walking on a rough wooden deck or boardwalk or stepping on shards of glass).

Usually, a splinter is fairly obvious. The person feels pain, and a sense that a foreign body is embedded in the skin. Often, the individual can see the splinter in or under the skin. The person may have only a small flow of blood or no bleeding at all. They may or may not be able to feel the splinter or a tip of it. Sometimes, the splinter is not noticed at all until an infection develops. Then, the area becomes red, swollen, warm, and tender.

Most splinters are easily removed at home without complications. On occasion, the person may need to see a doctor.

• A splinter under a fingernail may be impossible to remove at home. Unless removed, it often becomes infected.
• Very deep splinters may require removal by a doctor. Some splinters may be lodged so deeply that only an anesthetic injection allows for a painless removal.
• Infection is usually noted with discharge (pus), increased pain, redness, swelling, or red streaking. This could be a sign that a foreign body has not been fully removed. All foreign bodies contain large amounts of germs. Even with complete removal and adequate cleansing, infection may still develop because the protective skin barrier was broken.
• Large splinters that interfere with sensation or movement have the potential for creating deep puncture wounds, which may embed in nerves and tendons (and even blood vessels).
• With uncooperative patients, such as children, it may be difficult to restrain a child and remove a splinter. If this is the case, seek medical help.
• An area of inflammation, which was previously the site of a splinter, may be a retained fragment.

For serious bleeding or complications from infection associated with splinters or deep puncture wounds, go to a hospital's emergency department.

Most splinters that are visible do not require any diagnostic tests. For deeply embedded splinters, ultrasound, CT scan, or MRI  (special types of imaging studies that provide better visualization of soft tissues) may be needed. Very large splinters may also require a CT scan or MRI if there is a possibility the splinter may have penetrated a bone, tendon, or a vital area. X-rays may aid in locating metallic splinters and occasionally glass as well.

Take the following steps to remove a splinter.

• Using a pair of tweezers, grab the protruding end of the splinter and pull it out along the direction it entered. Wash the area with soap and water.
• At times, splinters may be fully embedded in the skin. Use a small needle sterilized in boiling water. Clean the skin with an antiseptic (such as Betadine or alcohol). Use the needle to gently and partially dislodge the splinter, which may then be removed fully with tweezers. Wash the area with soap and water.
• If a splinter appears to be too deep to attempt removal at home, see your doctor. If you have only been able to remove a portion of the splinter and foreign material remains embedded in the skin, the doctor should be able to remove the rest.

The best treatment for a splinter is to remove it.

• Deep splinters may require the physician to numb the area, and then make an incision with a scalpel in order to remove the splinter.
• The doctor attempts to remove all fragments of the foreign body and cleanse the area.
• If the splinter is underneath the fingernail, the physician may have to remove a portion of the fingernail to allow removal of the entire splinter.
• If the patient has an infection, the doctor will clean the area and explore the infected area to remove the splinter.
• If there are signs of inflammation, the doctor will either explore the area or remove the inflamed area with a scalpel. This ensures removal of the splinter.
• The doctor may prescribe antibiotics.
• If the doctor feels that the patient's wound is too large to leave open, he or she may use one of several methods (such as stitches) to close it. If the wound is infected, the doctor probably won't suture it closed.
• Depending on whether their vaccinations are current, patients may require a tetanus shot.

Most splinters are removed easily at home, and no infection develops. If splinters are not removed, they may become inflamed and lead to infection.