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

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

Extremity trauma

• Compartment syndrome
• Contusion
• Crush syndrome
• Degloving injury
  • Morel-Lavallée lesion
  • Ring avulsion injury
• Fracture
  • Open fracture
• Laceration
• Myositis ossificans
• Open joint injury
• Peripheral nerve injury
• Rhabdomyolysis
• Tendon injury
• Vascular injury

Evaluation

• Hand exam
  • Assess for distal neurovascular function
• Dedicated digit x-ray

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

• https://www.orthobullets.com/hand/6061/ring-avulsion-injuries