Ring avulsion injury

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
  • Finger amputation
  • Fingertip laceration
  • Nail avulsion
  • Nailbed laceration
  • Subungual hematoma
• Other finger/thumb
  • Boutonniere deformity
  • Mallet finger
    • Swan neck deformity
  • Jammed finger
  • Jersey finger
  • Trigger finger
  • Ring avulsion injury
  • De Quervain tenosynovitis
  • Infiltrative tenosynovitis
  • Metacarpophalangeal ulnar ligament rupture (Gamekeeper's thumb)
• Hand
  • Dupuytren contracture
• 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 dislocations
  • Hand and finger fractures
  • Hand and finger infections
  • Gout and pseudogout
  • Hand and finger tendon injuries
  • High-pressure injection injury
  • Osteoarthritis
  • Rheumatoid arthritis
  • Ring removal

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

• Digital mixoid cyst

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

• Degloving injury

External Links

• [1]