Epidemiology and Clinical Outcome of Entrapped Finger Rings: Experience from a Tertiary Health Institution

Richard C. Echem¹ and Phillip D. Eyimina^1,

¹Department of Orthopaedic Surgery, University Of Port Harcourt Teaching Hospital, Port Harcourt, Post Code – 500001, Rivers State, Nigeria

Cite this paper:
Richard C. Echem and Phillip D. Eyimina. Epidemiology and Clinical Outcome of Entrapped Finger Rings: Experience from a Tertiary Health Institution. American Journal of Medical Sciences and Medicine. 2019; 7(1):13-20. doi: 10.12691/ajmsm-7-1-4

Abstract

Background: Ring entrapment could occur and they present to the emergency department. In our environment it is uncommon. Aim: To describe the epidemiology and clinical outcome of patients presenting with entrapped finger rings to a tertiary health institution. Methods: Prospective study of patients with entrapped finger ring(s) presenting to the University of Port Harcourt Teaching Hospital between 1^st October 2007 and 30^th September 2018. A nondestructive traction technique utilizing electric cables was used to remove the entrapped ring(s). Data obtained was analyzed using IBM’s Statistical Package for Social Sciences (SPSS) version 23. Results: Twenty five patients presented with entrapped finger rings. Most were in the 17-22 years age group. There were 10 males and 15 females, with slightly more singles. More had tertiary education. Majority presented with finger swelling and pain with no vascular or neurological compromise. Duration the rings were worn ranged from one day to five years. Most rings were entrapped for five days or less. Left ring finger was most involved. Tight rings were common. All the patients had attempted severally to remove the entrapped rings and all used soap and water and petroleum jelly. The patients and neighbours were involved. Median duration of ring removal was 45 seconds. Mostly abrasions complicated initial removal process. Abrasions and laceration complicated the procedure. All entrapped rings were successfully removed utilizing the electric cables. Conclusion: The younger age group and females are most affected. Majority had no vascular or neurological compromise. Electric cable traction technique successfully removed all entrapped rings.

Keywords:
ring entrapment finger epidemiology clinical outcome emergency department

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	Allen KA, Rizzo M, Sadosty AT. A method for the removal of tungsten carbide rings. J Emerg Med 2012; 43(1): 93-96.
[2]	Kapickis M, Kutz JE. Titanium alloy ring crush injury. Am J Emerg Med 2007; 25(9): 1084. e3-1084.e5.
[3]	Salibi A, Morritt AN. Removing a Titanium wedding ring. Emerg Med J 2016; 33(2): 170.
[4]	Chambers AF, Harper A. Removal of a titanium ring using a dental saw. J Plast Reconstr Aesthet Surg 2012; 65(5): e128-e129.
[5]	Bleibleh S, Childs J, Baqai N. Removal of a titanium alloy ring. Br J Hosp Med (Lond) 2011; 72(9): 529.
[6]	McCarver S, Jeffery SL. Technical tip: removal of tungsten carbide rings. J R Army Med Corps 2013; 159(1): 64.
[7]	Moser A, Exadaktylos A, Radke A. Removal of a tungsten carbide ring from the finger of a pregnant patient: a case report involving emergency departments and the internet. Case Rep Emerg Med 2016; 2016: 8164524.
[8]	Ricks P. Removal of a tungsten carbide wedding ring with a diamond tipped dental drill. J Plast Reconstr Aesthet Surg 2010; 63(9): e701-e702.
[9]	Hajduk SV. Emergency removal of hard metal or ceramic finger rings. Ann Emerg Med 2001; 37(6): 736.
[10]	Matcuk GR Jr, Learch TJ, Keesara SR. Chronic circumferential periostitis of proximal phalanges related to tight fitting rings. Emerg Radiol 2006; 13(2): 89-93.
[11]	Kalkan A, Kose O, Tas M, Meric G. Review of techniques for the removal of trapped rings on fingers with a proposed new algorithm. Am J Emerg Med 2013; 31(11): 1605-1611.
[12]	Chiu TF, Chu SJ, Chen SG, Chen SL, Chen TM. Use of a Penrose drain to remove an entrapped ring from a finger under emergent conditions. Am J Emerg Med 2007; 25(6): 722-723.
[13]	Shamsuddin SR, Hashim AA, Berahim N, Fauzi H, Wahab SF, Noh AY. The use of dental drill in removing entrapped finger by metal ring in emergency department. Med J Malaysia 2012; 67(3): 349-350.
[14]	Gardiner CL, Handyside K, Mazzillo J, Hill MJ, Reichman EF, Chathampally Y, King BR. A comparison of two techniques for tungsten carbide ring removal. Am J Emerg Med 2013; 31(10): 1516-1519.
[15]	Ramponi DR. Don’t get uptight about ring removal. Nursing 2002; 32(12): 56-57.
[16]	Kingston D, Bopf D, Dhanjee U, McLean A. Evaluation of a two rubber band technique for finger ring removal. Ann R Coll Surg Engl 2016; 98(5): 300-302.
[17]	Baker A, Rylance K, Giles S. The occasional ring removal. Can J Rural Med 2010; 15(1): 26-28.
[18]	Burbridge MT, Ritter SE. An alternative method to remove a ring from an edematous finger. Am J Emerg Med 2009; 27(9): 1165-1166.
[19]	Thilagarajah M. An improved method of ring removal. J Hand Surg Br 1999; 24(1): 118-119.
[20]	Taylor SP, Boyd MJ. Unusually difficult ring removal from a finger solved using a dental instrument. Emerg Med Australas 2005; 17(3): 285-287.
[21]	Louw J, Hodgson E. Ujuzi: An unconventional ring removal technique for hard-to-remove rings (Practical Pearl/ Perle Pratique). Afr J Emerg Med 2012; 2(2): 81-83.
[22]	Ramyil VM, Dakum NK, Ayuba LN, Iya D. Ring entrapment of the finger in a psychiatric patient. Niger J Surg Res 2001; 3(1): 37-40.
[23]	Echem RC, Eyimina PD, Adiela VU. Removal of entrapped rings from swollen fingers by a nondestructive technique. In: Book of Abstracts, 53rd Annual Scientific Conference of the West African College of Surgeons (WACS) held from 10th -16th March, 2013 in Lome, Togo; 351.
[24]	Cornwall Fire and Rescue Service. Request and response: Removal of object from person or removal of person from object or similar. Reference number: IAR-101002150012. Cornwall: Cornwall Fire and Rescue Service (Cornwall Council).
[25]	London Fire Brigade. Brigade braced for Fifty Shades of Grey influence on call outs. 12th February 2015. Available from https://www.london-fire.gov.uk/news/2015-news/brigade-braced-for-fifty-shades-of-grey-influence-on-call-outs/. Accessed 20th November 2018.
[26]	Musa A. Stuck objects on fingers: pattern seen in a Nigerian teaching hospital and technique for removal. South Sudan Med J 2012; 5(1): 25.
[27]	Tiwari A, Bhatnagar N, Thora A, Sharma A, Kishan H, Jena S. Finger trapped in door latch removed using an electric saw. A new technique and review of other techniques. J Clin Orthop Trauma 2016; 7(3): 215-217.
[28]	Hajivassiliou CA. Trapped fingers. BMJ 1994; 308(6925): 409-410.
[29]	Cheah PK, Yang XY, Kamalludin A, Soo TL. Guidewire technique: removal of a doorknob in tourniquet syndrome. Int J Case Rep Images 2017; 8(4): 233-238.
[30]	Kim JW, Jun DH, Kim HJ. Manual removal of a finger stuck tightly in a door handle: the lubricant and compressor technique. J Korean Soc Emerg Med 2012; 23(2): 292-294.
[31]	Alexander G, Alexander R. An unusual form of ‘finger stuck in a hole’ injury in a child. Indian J Plast Surg 2012; 45(3): 585-586.
[32]	Porter ML. Getting stuck- the anthropometry of young children’s fingers. In: Annual Conference of the Ergonomics Society, 10th -12th April 2001, Royal Agricultural College, Cirencester.
[33]	Ostergaard LJ, Friis ML, Strabo S. [Digital strangulation – released by the use of a dentist’s drill]. Ugeskr Laeger 1995; 157(5): 594.
[34]	Cresap CR. Removal of a hardened steel ring from an extremely swollen finger. Am J Emerg Med 1995; 13(3): 318-320.
[35]	Chandra A, Muchedzi T. Ujuzi: Ring removal: A critical emergency procedure (Practical Pearl/Perle Pratique). Afr J Emerg Med 2012; 2(3): 127-128.
[36]	Hove LM, Odland P. Chronic erosion of a digit caused by a ring. Case report. Scand J Plast Reconstr Surg Hand Surg 1993; 27(3): 237-238.
[37]	Leung YF, Ip SP. Chronic erosion injury of a digit by a ring: epidemiology, staging, treatment and prognosis. Br J Plast Surg 2002; 55(4): 353-355.
[38]	Uemura T, Takamatsu K, Okada M, Ikeda M, Nakamura H. Entrapment of digital nerves due to an embedded ring: a case report. J Reconstr Microsurg 2014; 30(9): 659-662.
[39]	Kuschner SH, Gellman H, Hume M. Embedded ring injuries. Clin Orthop Relat Res 1992; (276): 192-193.
[40]	Unlu C, van Loon J, Maas M. Seventeen embedded rings resulting in chronic erosion injuries to four digits. J Hand Surg Eur Vol 2007; 32(6): 719-720.
[41]	Witt PD. Uncommon features of an uncommon problem: embedded ring syndrome in a child. Plast Reconstr Surg 2007; 119(5): 1631-1632.
[42]	Awan B, Samargandi OA, Aljaaly HA, Makhdom AM. Single patent vessel over an embedded ring: a case report. Hand Surg 2013; 18(1): 125-128.
[43]	Langridge BJ, Ramman S, Toft NJ. Embedded ring injury- a rare presentation with an atypical aetiology. Int Wound J 2017; 14(6): 1052-1054.
[44]	De Silva WV, Sritharan S. A single method to remove a tight ring using two nylon strings attached to a curved needle. Ceylon Med J 2018; 63(2): 82-83.
[45]	Ramesh BA, Satish Kumar J. Ring finger necrosis due to a ring. Indian J Surg 2017; 79(4): 367-368.
[46]	Burda R, Morochovic R, Kitka M. [ A ring grown into a finger in a female patient with alcohol abuse ]. Rozhl Chir 2010; 89(2): 148-149.
[47]	Zeng BW, Guo YJ, Huang CC. Embedded ring injury of the middle finger in an amphetamine abuser. J Chin Med Assoc 2006; 69(2): 95-97.
[48]	Exner FB. Removal of ring from swollen finger. JAMA 1969; 210(3): 558.
[49]	Manca D. Practice tips. Ring and string. How to remove a ring using a string. Can Fam Physician 1997; 43: 859.
[50]	Kates SL. A novel method of ring removal from the aging finger. Geriatr Orthop Surg Rehabil 2010; 1(2): 78-79.
[51]	Brock S, Kuhn W. Removal of constricting bands using the Dremel drill. Acad Emerg Med 1999; 6(11): 1182-1183.
[52]	Fasano FJ Jr, Hansen RH. Foreign body granuloma and synovitis of the fingers: a hazard of ring removal by the sawing technique. J Hand Surg Am 1987; 12(4): 621-623.