Splinters

Splinters

A splinter is a small, firm foreign body embedded in the skin or soft tissue. The most common type of splinter is wooden, either as an irregular fragment, or perhaps a thorn or a fragment of a toothpick. Other types of splinters could include various metals, glass, fiber glass, plastic, tooth fragments from a bite, or bone fragments from a nearby fracture. The urgency to remove a splinter depends upon the unique circumstances of the occurrence. The most common reasons to remove a splinter would be to reduce pain and prevent splinter-borne infection. Sometimes removing a splinter could be as simple as grasping it with forceps (“tweezers”) and pulling it out. Sometimes a sterile needle can be used to coax the splinter out. One type of superficial “splinter” is a bee stinger which can be carefully removed sometimes by rubbing over it with the firm edge of a credit card. At other times, when the splinter is more covert, other techniques and considerations have to be utilized.

Let’s consider for a second a case where a wood splinter is suspected but not seen. There is a puncture which could be an entry wound. The thing about wood is that it stirs up such a strong foreign body reaction; it simply has to come out to prevent infection and other complications. If there were “tenting” of the skin beyond the puncture it would be a pretty good bet that a splinter lay beneath. As a matter of the usual practice in treatment of puncture wounds, the area would be cleaned up with iodine soap, and a tetanus shot would be given if there had not been one in the last 5 years. The puncture wound would be gently infiltrated with local anesthetic to relieve discomfort. The next step would probably be to get plain x-rays of the area, from at least two views. If we’re lucky, the wood would show up. If it doesn’t, and we still suspect it, we could get a portable ultrasound to try to visualize it. This works quite well. Finally, however, if it has not been specifically seen it could be viewed under a fluoroscope, or visualized in the CT scanner. Now the doctor and the patient (or parent) has to put their heads together and figure out what course to take. There are three options: the doctor says,” I can take the splinter out,” or “I can’t take the splinter out; I will have to refer you to a surgeon,” or “I don’t think there is a splinter in there.” If the doctor believes he can take the splinter out he generally should specify: What anesthesia will be used; what tissue will be cut off if any; whether stitches will be necessary; what are the potential complications? What if we do nothing?

The same considerations would apply to other splinters. Substances like stainless steel fragments or a person’s own bone fragments would probably be more or less inert and not have to be removed. Glass splinters would have to be considered on a case by case basis. If there were large glass splinters which continued to cut and irritate the surrounding tissue, they might need to come out. Gravel splinters would probably need to be removed by some technique due to their infectious potential. Plastic might be inert depending on its composition and the mechanism of injury. Bullet fragments and splinters are often left alone and set up for drainage. Bullet shots are usually supersonic and the air friction produces heat and the bullet usually arrives to the target sterile. It is the shirt, coat, or a skin bacterium that gets pushed into the wound that is the problem.

The take home lesson is this: if a splinter is superficial and right there where you can gently tug it out, go ahead. Be aware, though, that additional splinters could be present that you’re not seeing. Check the splinter site frequently after removal for signs of infection or foreign body reaction. Don’t dig around in a wound with a “sterilized” needle trying to find a splinter. This could really stir up a nasty infection. If there’s any doubt in your mind, or if there appears to be a foreign body reaction or infection, consult a physician with the skills to evaluate and possibly remove it. There are matters of proper wound cleaning and tetanus immunization which may need to be addressed, lean toward the option of early physician consultation. If redness or streaking appears at or near the site or if pus is coming out of site get medical help as soon as possible.

John Drew Laurusonis M.D.
Doctors Medical Center