THE MORNING REPORT

The Best in FOAM Education

  • Philip Siva Vittozzi Wong, MD

How to Remove an Entrapped Ring


Cases

  • 65 year old female presents for 4th digit swelling and pain after trying to remove her ring, realizing that it will not slide off. She doesn't care about the ring and doesn’t mind you cutting it.

  • 40 year old male who presents for the same complaint, however he really cares about the ring and does not want you to break the ring.

  • 21 year old male who presents for pain and swelling on his penis after placing a ring to maintain and erection. He is embarrassed so he presents after the ring has been in place for 48 hours.

  • 5 year old female who was going through dad’s tool box, presents to the ED with a washer stuck on her finger

How do you approach these cases?

Before Ring Removal

  • Determine how long the ring has been on the digit or external genitalia, the composition of the ring, and removal methods already attempted

  • Treat infections and allergic reactions in a timely manner if these are the cause of the swelling and entrapment

  • Quickly remove rings when signs of ischemia are present (e.g. delayed capillary refill)

  • If necessary perform a digital or penile block. Remember to avoid lidocaine containing epinephrine

  • Elevating the extremity and using ice can help reduce the edema

Methods of Removal

Methods that involve breaking the ring

  • Ring cutter

  • Remember that this generates heat and it can burn the skin

  • Drip ice water onto the ring in order to prevent burns

  • If the ring is made of steel, titanium, or tungsten carbide, ring cutters will not work

  • Raptors Leatherman shears

  • Dental Drill, electric saw, Dremel motor saw

  • Use these tools for steel, titanium, or tungsten carbide rings

  • These tools are also needed for objects other than rings like washers and nuts that often involve pediatric patients

  • Sometimes two cuts may be necessary in order to remove the ring

  • Locking pliers or vise grip for tungsten carbide rings

  • Tungsten carbide is tough but brittle

Methods for intact ring removal

  • Winding technique

  • Penrose drain

  • Glove method

  • Two strings method

Philip Siva Vittozzi Wong, MD is a current third year resident at Stony Brook Emergency Medicine.

References

All of the material presented is explained with pictures in the references below. There is also an algorithm that will help you treat this condition with efficiency.

Edited by Bassam Zahid, MD

#ringentrapment #ringremoval #orthopedics

Stony Brook
EMergency Medicine

(631) 444-3880

 

101 Nicolls Road,

Stony Brook, NY 11794

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