Ring Avulsion Injuries



Ring Avulsion Injuries


Evan H. Horowitz

Michael Guju

Francisco A. Schwartz-Fernandes



INTRODUCTION



  • Definition



    • Acute trauma to a finger caused by a sudden force on a ring, leading to skin and soft tissue damage.1


    • Ring avulsion injuries vary in severity, ranging from bruising to traumatic amputation of the finger.1


    • Such injuries often occur to people who work with machinery while wearing a ring.1


  • Incidence and risk factors



    • Incidence



      • Wearing a ring or wedding band accounts for 90% of finger avulsion cases that are treated in hospital departments and 13% to 15% of digit amputations per year.2


      • Average ratio of 300 cases per year for a population of 60 million in industrialized countries.2


    • Risk factors/epidemiology



      • Young men, average age 31 years at highest risk2



        • Majority of patients of age 21 to 40 years, commonly working men3


      • Occupational hazards involving the use of hands to operate machinery and/or lift heavy objects


CLASSIFICATION OF AVULSION INJURIES




  • Mechanism



    • Ring gets caught and anchored on a heavy, moving object such as a door, fence, or piece of heavy machinery. As the object continues to move, the ring may avulse the underlying tissues.



    • Biomechanics (Table 57.2)



      • The average maximum force resulting in class I injuries is 80 N.4


      • The average maximum force producing amputation in class III injuries was 154 N. Force measurements for class II injuries were nearly identical to those of class III.4



  • Prognosis



    • The extent of artery, vein, and nerve involvement varies and can be used to classify these injuries and determine prognosis.1,18


    • Recent advancements in microsurgery,5 such as revascularization and replantation, have improved prognosis and outcomes.6


    • Kay et al concluded that extent of skeletal injury is a significant prognostic factor and proposed a revision of the Urbaniak et al classification.7








TABLE 57.1 The Urbaniak Classification of Avulsion Injuries and the Kay Classification With adani Modifications1,5,7,14






























Urbaniak Classification


I


Avulsion injury with adequate circulation


II


Incomplete avulsion injury with inadequate circulation


III


Avulsion injury with complete degloving or amputation


Kay Classification as Modified by Adani


I


Avulsion injury with adequate circulation


II


Incomplete avulsion injury with inadequate arterial or venous circulation, no skeletal injury


IIa Arterial circulation inadequate only


IIv Venous circulation inadequate only


III


Incomplete avulsion injury with inadequate arterial or venous circulation, fracture or joint injury present


IIIa Arterial circulation inadequate only


IIIv Venous circulation inadequate only


IV


Avulsion injury with complete degloving or amputation


IVp Complete avulsion injury with amputation proximal to FDS insertion


IVd Complete avulsion injury with amputation distal to FDS insertion


FDS, flexor digitorum superficialis.









TABLE 57.2 Tensile Strengths of Rings based on Their Type and Material, and the Common Classes of Injuries Associated With Different Rings2























Type of Ring


Material


Average Tensile Strength (N)


Type of Injuries


Open ring


Nickel-free alloy or silver


21-52.5


Class I injuries


Bejeweled, squared closed, or signet ring


Steel, resin Plexiglas, or Sumac wood


147-203


Class I-III Injuries (at up to 351 N, risk of severe impairment, or class III and IV, is limited to 14% of cases)


Closed, three-strand braided, or signet ring


Jade, aluminum, silver, gold-plate, or steel


624-999


Very high risk of class IV injuries

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May 7, 2019 | Posted by in ORTHOPEDIC | Comments Off on Ring Avulsion Injuries
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