Ring avulsion injury: Difference between revisions
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*History of working with machinery or getting digit caught in door | *History of working with machinery or getting digit caught in door | ||
*Pain, bleeding, lack of sensation | *Pain, bleeding, lack of sensation | ||
*Three classes of injury based on circulatory status | |||
**Class I: Circulation adequate | |||
**Class II: Circulation inadequate | |||
**Class III: Complete degloving or complete amputation | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Evaluation== | ==Evaluation== | ||
*Assess for distal neurovascular function | *[[Hand exam]] | ||
**Assess for distal neurovascular function | |||
*Hand/dedicated digit Xray | *Hand/dedicated digit Xray | ||
==Management== | ==Management== | ||
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==External Links== | ==External Links== | ||
*[https://www.orthobullets.com/hand/6061/ring-avulsion-injuries] | |||
==References== | ==References== | ||
<ref>Jones M, Gujral S. Ring Avulsion Injuries. Eplasty. 2016;16:ic5.</ref> | |||
<references/> | <references/> | ||
Revision as of 06:32, 19 March 2018
Background
- Sudden pull on a ring results in severe soft tissue avulsion injury
- Can range from circumferential soft tissue laceration to complete amputation
- Often with concomitant neurovascular damage
Clinical Features
- Typically only one digit involved
- History of working with machinery or getting digit caught in door
- Pain, bleeding, lack of sensation
- Three classes of injury based on circulatory status
- Class I: Circulation adequate
- Class II: Circulation inadequate
- Class III: Complete degloving or complete amputation
Differential Diagnosis
Hand and finger injuries
- Distal finger
- Other finger/thumb
- Boutonniere deformity
- Mallet finger
- Jammed finger
- Jersey finger
- Trigger finger
- Ring avulsion injury
- De Quervain tenosynovitis
- Infiltrative tenosynovitis
- Metacarpophalangeal ulnar ligament rupture (Gamekeeper's thumb)
- Hand
- Wrist
- Drummer's wrist
- Ganglion cyst
- Lunotriquetral ligament instability
- Scaphoid fracture
- Extensor digitorum tenosynovitis
- Compressive neuropathy ("bracelet syndrome")
- Intersection syndrome
- Snapping Extensor Carpi Ulnaris
- Vaughn Jackson syndrome
- General
Hand and finger infections
- Bed bugs
- Closed fist infection (Fight Bite)
- Hand cellulitis
- Hand deep space infection
- Hand-foot-and-mouth disease
- Herpetic whitlow
- Felon
- Flexor tenosynovitis
- Paronychia
- Scabies
- Sporotrichosis
Look-Alikes
Evaluation
- Hand exam
- Assess for distal neurovascular function
- Hand/dedicated digit Xray
Management
- Will require consultation with hand surgeon for operative repair
- Antibiotics
- Cefazolin 1 g IV
- Tetanus prophylaxis
Disposition
- Admit
See Also
External Links
References
- ↑ Jones M, Gujral S. Ring Avulsion Injuries. Eplasty. 2016;16:ic5.