The Journal of Emergency Medicine, Vol. -, No. -, pp. 1–2, 2014 Copyright Ó 2014 Elsevier Inc. Printed in the USA. All rights reserved 0736-4679/$ - see front matter
http://dx.doi.org/10.1016/j.jemermed.2014.09.051
Visual Diagnosis in Emergency Medicine
AN EMBEDDED FINGER RING Tiarnan A. Magos, BSC, MB BS, MRCS (ENT) and Zeeshan Sheikh, MB CHB, MRCS, FRCS (PLAST) Department of Plastic and Reconstructive Surgery, St. John’s Hospital, West Lothian, Scotland Reprint Address: Tiarnan A. Magos, BSC, MB BS, MRCS (ENT), Department of Plastic and Reconstructive Surgery, St. John’s Hospital, Howden Road West, Livingston, West Lothian, Scotland EH54 6PP
and upper limb were normal on inspection. The ring was removed using a ring cutter under local anesthetic using a ring block, and the wounds were cleaned and dressed. She had full function of her finger after the procedure was performed.
INTRODUCTION We present a case of a 71-year-old woman with a partially embedded finger ring in her left ring finger after a mechanical fall and laceration to the finger approximately 9 weeks earlier. It was removed on the ward under local anesthetic without event.
DISCUSSION Post-traumatic embedded rings are very rarely encountered. Reported cases are usually in adult female patients, often with underlying psychiatric illnesses (1–6). There was been one report involving a child and one report
CASE REPORT A 71-year-old woman being actively treated for a medical condition on the elderly ward was incidentally noticed to have an embedded ring on her left ring finger by her ward physicians. She had a history of subarachnoid hemorrhage at age 50 years and lived independently alone at home. She had no history of psychiatric illness. She had been widowed at age 69 years. She had fallen 9 weeks before admission and lacerated her left ring finger but chose not to remove her ring. The patient’s left ring finger had approximately 75% of a complete gold wedding ring embedded within it (Figures 1 and 2). The rest of it was covered with a layer of epithelium. The finger had a full range of movement and had no neurovascular deficit. There was no evidence of infection. The ring was rotatable and was not painful to move. The rest of the finger, hand, All persons gave their informed consent before their inclusion in this paper.
Figure 1. Dorsal view of partially embedded ring in the left ring finger.
RECEIVED: 30 May 2014; FINAL SUBMISSION RECEIVED: 11 September 2014; ACCEPTED: 30 September 2014 1
2
T. A. Magos and Z. Sheikh
only a small section of the ring is embedded or indeed not embedded. In a patient with a history of upper limb trauma, close inspection of all digits should be undertaken. Prompt removal of any finger rings is important to prevent post-traumatic complications, including, but not limited to, swelling, obstruction of venous or arterial flow, and post-traumatic embedded ring.
REFERENCES
Figure 2. Volar aspect of left ring finger, illustrating volar aspect of ring completely embedded subepithelially.
involving a drug abuser (7,8). The natural history includes an initial injury to the finger and gradual reepithelialization over the ring, usually without any neurovascular deficit and only mild discomfort (9). Functional deficit has been described with a late-presenting embedded ring, caused by subcutaneous fibrosis and resultant adhesions and contracture (1). Management depends on the extent of re-epithelialization, nonsurgical removal is often possible (10). Surgical removal techniques range from debridement of granulation tissue to excision (1,2,4). Post-traumatic embedded finger rings are a rare occurrence, but can be effectively managed without significant functional sequela (11,12). On first inspection, a partially embedded ring may be difficult to diagnose, especially if
1. Leung YF, Ip SP. Chronic erosion injury of a digit by a ring; epidemiology, staging treatment and prognosis. Br J Plast Surg 2002;55: 353–5. 2. Fleeter TB, Gunther SF. The embedded ring case report and review of literature. Orthopedics 1985;8:999. 3. Drake DDA, Lewis F, Newmayer WL, et al. An unusual ring injury. J Hand Surg 1977;2A:111–2. 4. Deshmukh NV, Stothard JS. The embedded ring injury—case report and review of literature. Hand Surg 2003;8:103–5. 5. Kumar A, Edwards H, Lidder S, Mestha P. Dangers of neglect: partially embedded ring upon a finger. BMJ Case Rep 2013;9:2013. 6. Balakrishnan C, Nyitray J. Unusual presentation of a ring injury in a psychiatric patient. J Psychosoc Nurs Ment Health Serv 1999;37: 37–8. 7. Bennett KG, Brou JA, Levine NS. Completely embedded ring in the finger of a growing child. Ann Plast Surg 1995;34:76–7. 8. Zeng BW, Guo YJ, Huang CC. Embedded ring injury of the middle finger in an amphetamine abuser. J Chin Med Assoc 2006;69:95–7. 9. Dreeniany JJ, Palmer AK, Levinsohn EM. An unusual presentation of a ring injury. J Hand Surg Am 1982;7:194–5. 10. Cresap CR. Removal of a hardened steel ring from an extremely swollen finger. Am J Emerg Med 1995;13:318–20. 11. Fraser KE. Embedded-ring syndrome. Ann Emerg Med 1995;25: 856–7. 12. Leong SCL, Stanislas MJ, Hyder N. The embedded ring injury. Inj Extra 2005;36:55–7.
http://dx.doi.org/10.1016/j.jemermed.2014.09.051
Visual Diagnosis in Emergency Medicine
AN EMBEDDED FINGER RING Tiarnan A. Magos, BSC, MB BS, MRCS (ENT) and Zeeshan Sheikh, MB CHB, MRCS, FRCS (PLAST) Department of Plastic and Reconstructive Surgery, St. John’s Hospital, West Lothian, Scotland Reprint Address: Tiarnan A. Magos, BSC, MB BS, MRCS (ENT), Department of Plastic and Reconstructive Surgery, St. John’s Hospital, Howden Road West, Livingston, West Lothian, Scotland EH54 6PP
and upper limb were normal on inspection. The ring was removed using a ring cutter under local anesthetic using a ring block, and the wounds were cleaned and dressed. She had full function of her finger after the procedure was performed.
INTRODUCTION We present a case of a 71-year-old woman with a partially embedded finger ring in her left ring finger after a mechanical fall and laceration to the finger approximately 9 weeks earlier. It was removed on the ward under local anesthetic without event.
DISCUSSION Post-traumatic embedded rings are very rarely encountered. Reported cases are usually in adult female patients, often with underlying psychiatric illnesses (1–6). There was been one report involving a child and one report
CASE REPORT A 71-year-old woman being actively treated for a medical condition on the elderly ward was incidentally noticed to have an embedded ring on her left ring finger by her ward physicians. She had a history of subarachnoid hemorrhage at age 50 years and lived independently alone at home. She had no history of psychiatric illness. She had been widowed at age 69 years. She had fallen 9 weeks before admission and lacerated her left ring finger but chose not to remove her ring. The patient’s left ring finger had approximately 75% of a complete gold wedding ring embedded within it (Figures 1 and 2). The rest of it was covered with a layer of epithelium. The finger had a full range of movement and had no neurovascular deficit. There was no evidence of infection. The ring was rotatable and was not painful to move. The rest of the finger, hand, All persons gave their informed consent before their inclusion in this paper.
Figure 1. Dorsal view of partially embedded ring in the left ring finger.
RECEIVED: 30 May 2014; FINAL SUBMISSION RECEIVED: 11 September 2014; ACCEPTED: 30 September 2014 1
2
T. A. Magos and Z. Sheikh
only a small section of the ring is embedded or indeed not embedded. In a patient with a history of upper limb trauma, close inspection of all digits should be undertaken. Prompt removal of any finger rings is important to prevent post-traumatic complications, including, but not limited to, swelling, obstruction of venous or arterial flow, and post-traumatic embedded ring.
REFERENCES
Figure 2. Volar aspect of left ring finger, illustrating volar aspect of ring completely embedded subepithelially.
involving a drug abuser (7,8). The natural history includes an initial injury to the finger and gradual reepithelialization over the ring, usually without any neurovascular deficit and only mild discomfort (9). Functional deficit has been described with a late-presenting embedded ring, caused by subcutaneous fibrosis and resultant adhesions and contracture (1). Management depends on the extent of re-epithelialization, nonsurgical removal is often possible (10). Surgical removal techniques range from debridement of granulation tissue to excision (1,2,4). Post-traumatic embedded finger rings are a rare occurrence, but can be effectively managed without significant functional sequela (11,12). On first inspection, a partially embedded ring may be difficult to diagnose, especially if
1. Leung YF, Ip SP. Chronic erosion injury of a digit by a ring; epidemiology, staging treatment and prognosis. Br J Plast Surg 2002;55: 353–5. 2. Fleeter TB, Gunther SF. The embedded ring case report and review of literature. Orthopedics 1985;8:999. 3. Drake DDA, Lewis F, Newmayer WL, et al. An unusual ring injury. J Hand Surg 1977;2A:111–2. 4. Deshmukh NV, Stothard JS. The embedded ring injury—case report and review of literature. Hand Surg 2003;8:103–5. 5. Kumar A, Edwards H, Lidder S, Mestha P. Dangers of neglect: partially embedded ring upon a finger. BMJ Case Rep 2013;9:2013. 6. Balakrishnan C, Nyitray J. Unusual presentation of a ring injury in a psychiatric patient. J Psychosoc Nurs Ment Health Serv 1999;37: 37–8. 7. Bennett KG, Brou JA, Levine NS. Completely embedded ring in the finger of a growing child. Ann Plast Surg 1995;34:76–7. 8. Zeng BW, Guo YJ, Huang CC. Embedded ring injury of the middle finger in an amphetamine abuser. J Chin Med Assoc 2006;69:95–7. 9. Dreeniany JJ, Palmer AK, Levinsohn EM. An unusual presentation of a ring injury. J Hand Surg Am 1982;7:194–5. 10. Cresap CR. Removal of a hardened steel ring from an extremely swollen finger. Am J Emerg Med 1995;13:318–20. 11. Fraser KE. Embedded-ring syndrome. Ann Emerg Med 1995;25: 856–7. 12. Leong SCL, Stanislas MJ, Hyder N. The embedded ring injury. Inj Extra 2005;36:55–7.
