Splinter

Last updated
Splinter
Other namesSliver
Splinter.jpg
Wooden splinter in a finger
Complications Infection
TypesWood, hair, glass, plastic, metal, and spines of animals
Risk factors Infection
Diagnostic method Ultrasonography

A splinter (also known as a sliver) is a fragment of a larger object, or a foreign body that penetrates or is purposely injected into a body. The foreign body must be lodged inside tissue to be considered a splinter. Splinters may cause initial pain through ripping of flesh and muscle, or infection through bacteria on the foreign object. [1]

Contents

Splinters are primarily made of wood, but there are many other types, for example, other common types of splinters are, hair, glass, plastic, metal, and spines of animals. [2]

As with any wound that breaks the skin, splinters can lead to infection, which if left untreated could develop into more serious complications. If a splinter is in the body for more than 2–3 days, or if the wound shows signs of inflammation or tenderness (whether the splinter was removed or not), advice should be sought from a doctor.

Getting a splinter

Generally, a splinter causes an initial feeling of pain as the sharp object makes its initial penetration through the body. Through this penetration, the object cuts through the cutaneous layer of the skin, and settles in the subcutaneous layer of the skin, and can even penetrate further down, breaking the sub-cutaneous layer, settling in muscle tissue, or even the bone. Some splinters will remain in place, but most will continue to migrate through the body (eg. hair splinters), further damaging their surroundings.

Types

Sea urchins may cause splinters Sea Urchins enjoying sunbathing.jpg
Sea urchins may cause splinters

According to the American Academy of Family Physicians, the most common foreign bodies contracted by people fall into two official classes: biological splinters, and nonbiological splinters. [3] In the biological class, splinters include bone, fish spines, teeth, hair and wood. Although, in the nonbiological class, common splinters contracted are glass, metal, aluminum, fishhooks, pencil graphite, and plastic.

Rarely, people may become infected with splinters from more unusual sources. Common cases of exotic foreign bodies include sea urchins, insect stings, stingray spines, and even grenade shrapnel.

Specific details of some splinters

Detection

Anatomy The Skin - NCI Visuals Online Anatomy The Skin - NCI Visuals Online.jpg
Anatomy The Skin - NCI Visuals Online

Splinters are often first detected by the person with the splinter in their body. There are many signs that a splinter has entered one's body.

Signs of a hidden foreign body

Imaging

Ultrasonography of a subcutaneous splinter (in a finger) 4 x 1mm with oblique stroke. ForeignBody Ultras 1.png
Ultrasonography of a subcutaneous splinter (in a finger) 4 x 1mm with oblique stroke.

If manual detection and localization fail, the main methods for medical imaging of splinters are:

Small wooden splinters (1–4 mm) distant from bones are most easily detected by ultrasonography, while CT scan and magnetic resonance imaging have higher sensitivity for those near bones. [7]

Removal

There are many medical techniques to remove splinters safely. [8] Common medical techniques include the Elliptical Technique and the String Technique. [9] In the elliptical technique the surrounding area of the splinter is sliced in an elliptical formation. From there the flesh in the elliptical area is cut (in the shape of an upside-down cone) and the whole chunk of flesh containing the splinter is removed. The Needle Cover Technique is limited to fishhook removal. A string is looped around the base of the hook, and as the hook is pressed further into the skin, the string is pulled, allowing the barbs to be unhooked from muscle and follow the path of the rest of the hook out of the body without snagging any additional flesh. [9] [10]

Since the splinter has penetrated through a physical barrier of the body it allows for an individual to get an infection. [11] The opening from the splinter will make it easier for bacteria to get into the body. It is strongly encouraged for the removal of a splinter before falling victim to an infection.

Infection

Infection is usually determined by the duration of time that the foreign object remains lodged in the human body. Objects that have included poison, deep penetration, dirt, or bite injuries generally result in a shorter time until infection is notable. According to the AAFP, patients that are older, or have diabetes, or have wounds that are longer, wider, more jagged or deeper, have a much higher risk of infection. Simply the easiest way to avoid infection is to completely remove the splinters or foreign body as soon as possible. Though infection is generally the largest complication encountered with splinters, ranging from 1.1 to 12 percent presence, the use of antibiotics in non-bite cases is generally deemed unnecessary by the medical community. [12] Though cases are rare, infection of foreign body wounds can result in cases of tetanus. [13]

One case of tetanus contraction through a splinter was seen in Ohio in 1993. An 80-year-old woman was presented to an ED with dysphagia and a stiff jaw. Not long after a preliminary checkup, a wood splinter was found to have been lodged in her chin for approximately 1 week; the area was erythematous with active purulent drainage. The woman was diagnosed with tetanus, admitted to the hospital, and begun on a regimen of 3,000 units of tetanus immune globulin, tetanus toxoid, and intravenous clindamycin. Despite aggressive treatment, including assisted mechanical ventilation, the patient died 15 days later from the effects of her primary infection. The woman had no history of previous tetanus vaccinations despite previous care for a wound and ongoing medical attention for hypertension. [14]

Since most splinters are made of organic matter, they are much more dangerous than other types of things puncturing the body. Splinters are usually infected with many bacteria which then turn into an infection such as tetanus. Due to a splinter being made of organic matter, it makes it much more difficult for the body to get rid of it. [15]

Related Research Articles

<span class="mw-page-title-main">Abscess</span> Localized collection of pus that has built up within the tissue of the body

An abscess is a collection of pus that has built up within the tissue of the body. Signs and symptoms of abscesses include redness, pain, warmth, and swelling. The swelling may feel fluid-filled when pressed. The area of redness often extends beyond the swelling. Carbuncles and boils are types of abscess that often involve hair follicles, with carbuncles being larger. A cyst is related to an abscess, but it contains a material other than pus, and a cyst has a clearly defined wall.

<span class="mw-page-title-main">Skin</span> Soft outer covering organ of vertebrates

Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation.

<span class="mw-page-title-main">Tetanus</span> Bacterial infection characterized by muscle spasms

Tetanus, also known as lockjaw, is a bacterial infection caused by Clostridium tetani and characterized by muscle spasms. In the most common type, the spasms begin in the jaw, and then progress to the rest of the body. Each spasm usually lasts for a few minutes. Spasms occur frequently for three to four weeks. Some spasms may be severe enough to fracture bones. Other symptoms of tetanus may include fever, sweating, headache, trouble swallowing, high blood pressure, and a fast heart rate. Onset of symptoms is typically 3 to 21 days following infection. Recovery may take months; about 10% of cases prove to be fatal.

<span class="mw-page-title-main">Ulcer (dermatology)</span> Type of cutaneous condition

An ulcer is a sore on the skin or a mucous membrane, accompanied by the disintegration of tissue. Ulcers can result in complete loss of the epidermis and often portions of the dermis and even subcutaneous fat. Ulcers are most common on the skin of the lower extremities and in the gastrointestinal tract. An ulcer that appears on the skin is often visible as an inflamed tissue with an area of reddened skin. A skin ulcer is often visible in the event of exposure to heat or cold, irritation, or a problem with blood circulation.

<span class="mw-page-title-main">Wound</span> Acute injury from laceration, puncture, blunt force, or compression

A wound is any disruption of or damage to living tissue, such as skin, mucous membranes, or organs. Wounds can either be the sudden result of direct trauma, or can develop slowly over time due to underlying disease processes such as diabetes mellitus, venous/arterial insufficiency, or immunologic disease. Wounds can vary greatly in their appearance depending on wound location, injury mechanism, depth of injury, timing of onset, and wound sterility, among other factors. Treatment strategies for wounds will vary based on the classification of the wound, therefore it is essential that wounds be thoroughly evaluated by a healthcare professional for proper management. In normal physiology, all wounds will undergo a series of steps collectively known as the wound healing process, which include hemostasis, inflammation, proliferation, and tissue remodeling. Age, tissue oxygenation, stress, underlying medical conditions, and certain medications are just a few of the many factors known to affect the rate of wound healing.

<span class="mw-page-title-main">Nail (anatomy)</span> Hard keratin protection of digit

A nail is a protective plate characteristically found at the tip of the digits of all primates, corresponding to the claws in other tetrapod animals. Fingernails and toenails are made of a tough rigid protein called alpha-keratin, a polymer also found in the claws, hooves and horns of vertebrates.

<span class="mw-page-title-main">Scalp</span> Anatomical area bordered by the face at the front, and by the neck at the sides and back

The scalp is the area of the head where head hair grows. It is made up of skin, layers of connective and fibrous tissues, and the membrane of the skull. Anatomically, the scalp is part of the epicranium, a collection of structures covering the cranium. The scalp is bordered by the face at the front, and by the neck at the sides and back. The scientific study of hair and scalp is called trichology.

<span class="mw-page-title-main">Dermoid cyst</span> Medical condition

A dermoid cyst is a teratoma of a cystic nature that contains an array of developmentally mature, solid tissues. It frequently consists of skin, hair follicles, and sweat glands, while other commonly found components include clumps of long hair, pockets of sebum, blood, fat, bone, nail, teeth, eyes, cartilage, and thyroid tissue.

<span class="mw-page-title-main">Skin condition</span> Any medical condition that affects the integumentary system

A skin condition, also known as cutaneous condition, is any medical condition that affects the integumentary system—the organ system that encloses the body and includes skin, nails, and related muscle and glands. The major function of this system is as a barrier against the external environment.

<span class="mw-page-title-main">Animal bite</span> Wound or puncture caused by animal teeth

An animal bite is a wound, usually a puncture or laceration, caused by the teeth. An animal bite usually results in a break in the skin but also includes contusions from the excessive pressure on body tissue from the bite. The contusions can occur without a break in the skin. Bites can be provoked or unprovoked. Other bite attacks may be apparently unprovoked. Biting is a physical action not only describing an attack but it is a normal response in an animal as it eats, carries objects, softens and prepares food for its young, removes ectoparasites from its body surface, removes plant seeds attached to its fur or hair, scratching itself, and grooming other animals. Animal bites often result in serious infections and mortality. Animal bites not only include injuries from the teeth of reptiles, mammals, but fish, and amphibians. Arthropods can also bite and leave injuries.

<span class="mw-page-title-main">Foreign body</span> Object originating outside the body of an organism

A foreign body (FB) is any object originating outside the body of an organism. In machinery, it can mean any unwanted intruding object.

<span class="mw-page-title-main">Human back</span> Body part

The human back, also called the dorsum, is the large posterior area of the human body, rising from the top of the buttocks to the back of the neck. It is the surface of the body opposite from the chest and the abdomen. The vertebral column runs the length of the back and creates a central area of recession. The breadth of the back is created by the shoulders at the top and the pelvis at the bottom.

<span class="mw-page-title-main">Veterinary surgery</span> Surgery performed on non-human animals

Veterinary surgery is surgery performed on non-human animals by veterinarians, whereby the procedures fall into three broad categories: orthopaedics, soft tissue surgery, and neurosurgery. Advanced surgical procedures such as joint replacement, fracture repair, stabilization of cranial cruciate ligament deficiency, oncologic (cancer) surgery, herniated disc treatment, complicated gastrointestinal or urogenital procedures, kidney transplant, skin grafts, complicated wound management, and minimally invasive procedures are performed by veterinary surgeons. Most general practice veterinarians perform routine surgeries such as neuters and minor mass excisions; some also perform additional procedures.

<span class="mw-page-title-main">Head and neck anatomy</span>

This article describes the anatomy of the head and neck of the human body, including the brain, bones, muscles, blood vessels, nerves, glands, nose, mouth, teeth, tongue, and throat.

<span class="mw-page-title-main">Penetrating trauma</span> Type of injury

Penetrating trauma is an open wound injury that occurs when an object pierces the skin and enters a tissue of the body, creating a deep but relatively narrow entry wound. In contrast, a blunt or non-penetrating trauma may have some deep damage, but the overlying skin is not necessarily broken and the wound is still closed to the outside environment. The penetrating object may remain in the tissues, come back out the path it entered, or pass through the full thickness of the tissues and exit from another area.

<i>Clostridium tetani</i> Common soil bacterium and the causative agent of tetanus

Clostridium tetani is a common soil bacterium and the causative agent of tetanus. Vegetative cells of Clostridium tetani are usually rod-shaped and up to 2.5 μm long, but they become enlarged and tennis racket- or drumstick-shaped when forming spores. C. tetani spores are extremely hardy and can be found globally in soil or in the gastrointestinal tract of animals. If inoculated into a wound, C. tetani can grow and produce a potent toxin, tetanospasmin, which interferes with motor neurons, causing tetanus. The toxin's action can be prevented with tetanus toxoid vaccines, which are often administered to children worldwide.

<span class="mw-page-title-main">Sea urchin injury</span> Medical condition

Sea urchin injuries are caused by contact with sea urchins, and are characterized by puncture wounds inflicted by the animal's brittle, fragile spines.Injuries usually occur when swimmers, divers, surfers, or fisherpeople accidentally contact a sea urchin with their hands or feet.

Rectal pain is the symptom of pain in the area of the rectum. A number of different causes (68) have been documented.

<span class="mw-page-title-main">Tetanus vaccine</span> Vaccines used to prevent tetanus

Tetanus vaccine, also known as tetanus toxoid (TT), is a toxoid vaccine used to prevent tetanus. During childhood, five doses are recommended, with a sixth given during adolescence.

Postoperative wounds are those wounds acquired during surgical procedures. Postoperative wound healing occurs after surgery and normally follows distinct bodily reactions: the inflammatory response, the proliferation of cells and tissues that initiate healing, and the final remodeling. Postoperative wounds are different from other wounds in that they are anticipated and treatment is usually standardized depending on the type of surgery performed. Since the wounds are 'predicted' actions can be taken beforehand and after surgery that can reduce complications and promote healing.

References

  1. "default - Stanford Children's Health". www.stanfordchildrens.org. Retrieved 2022-03-21.
  2. Capellan O., Hollander, J.E. (2003). Management of lacerations in the emergency department. Emerg. Med. Clin. North. Am.21, 205–31.
  3. American College of Emergency Physicians: clinical policy for the initial approach to patients presenting with penetrating extremity trauma. Ann Emerg Med. 1999;33:612–36.
  4. "What happens if you don't remove a splinter?". www.abc.net.au. 2017-06-28. Retrieved 2020-06-26.
  5. Trüeb, Ralph M.; Luu, Ngoc-Nhi Catharina; Gavazzoni Dias, Maria Fernanda Reis (May 11, 2022). "Not So Uncommon Cause of Foot Pain: Cutaneous Hair Splinter of the Sole". Skin Appendage Disorders. 8 (3): 256–260. doi:10.1159/000520573. PMC   9149401 . PMID   35707295.
  6. Tibbles CD, Porcaro W. "Procedural applications of ultrasound." Emerg Med Clin North Am. 2004; 22: 797–815.
  7. Mizel, Mark S.; Steinmetz, Neil D.; Trepman, Elly (1994). "Detection of Wooden Foreign Bodies in Muscle Tissue: Experimental Comparison of Computed Tomography, Magnetic Resonance Imaging, and Ultrasonography". Foot & Ankle International. 15 (8): 437–443. doi:10.1177/107110079401500807. ISSN   1071-1007. PMID   7981816. S2CID   24868606.
  8. "Splinter removal: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 2021-10-27.
  9. 1 2 Blankstein A, Cohen I, Heiman Z, Salai M, Diamant L, Heim M, et al. Ultrasonography as a diagnostic modality and therapeutic adjuvant in the management of soft tissue foreign bodies in the lower extremities. Isr Med Assoc J. 2001;3:411–3.
  10. "How to remove a splinter". www.aad.org. Retrieved 2022-03-21.
  11. "What Happens if You Don't Take Out a Splinter?". Live Science . 15 June 2019.
  12. Broder KR, Cortese MM, Iskander JK, Kretsinger K, Slade BA, Brown KH, et al., for the Advisory Committee on Immunization Practices (ACIP). Preventing tetanus, diphtheria, and pertussis among adolescents: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccines recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2006;55RR-31–34.
  13. Rupert, Jedda; Honeycutt, James David; Odom, Michael Ryan (2020-06-15). "Foreign Bodies in the Skin: Evaluation and Management". American Family Physician. 101 (12): 740–747. ISSN   0002-838X. PMID   32538598.
  14. Buttaravoli PM, Stair TO. Minor emergencies: splinters to fractures. St. Louis: Mosby, 2000;471–7.
  15. "Here's What Happens if You Don't Remove a Splinter". 2 April 2017.