Ring Injuries of the Finger: Long-Term Follow-up

Author:

Crosby Nicholas1,Hood John1,Baker Graeme23,Lubahn John1

Affiliation:

1. Orthopaedic Institute, UPMC Hamot, 201 State Street, Erie, PA 16550, USA

2. Plastic Surgery, Georgia Institute for Plastic Surgery, Savannah, GA, USA

3. 300 State Street, Suite 205, Erie, PA 16507, USA

Abstract

Purpose The purpose of this study was to report on the injury patterns and outcomes of a series of patients treated at our institution between the years 1983 and 2010 who were injured by rings worn on their finger. The series included typical ring avulsion injuries as well as all other injuries caused by rings. Methods Retrospective chart review was conducted on 33 patients with ring injuries treated by the senior author and colleagues. Eight cases were classified as Urbaniak class I, 13 class II, and 12 class III. Results Satisfactory finger motion occurred with salvage of fingers in which no damage occurred to the proximal phalanx or flexor digitorum sublimus or profundus tendons. All patients with flexor tendon injury or proximal phalangeal fracture or both had loss of PIPJ motion and total active motion as compared to class II injuries without tendon and bone involvement. Four class III injuries were treated with replantation. One failed requiring revision amputation at the metacarpalphalangeal joint level due to ischemia. The remaining eight were treated by primary amputation. Conclusions As a guideline to digit salvage with ring injuries, the authors propose accurately documenting and basing treatment on all injured structures. Particular attention should be given to fractures of the proximal phalanx and laceration of the flexor digitorum sublimus and profundus tendons, as injury to these structures led to significant loss in mobility of the finger in this series. While some current guidelines advise revascularization of class II ring avulsion injuries, our series suggests caution in anticipating good results with sublimus or profundus tendon laceration and proximal phalanx fracture. If the profundus tendon only is lacerated, particularly in zone I injuries, results of finger salvage may still be acceptable, but associated (distal interphalangeal joint) DIPJ injury may require K-wire stabilization and later fusion. Replantation in class III injuries, while possible, is warranted only in select situations (patient-specific and cultural factors).

Publisher

SAGE Publications

Subject

Orthopedics and Sports Medicine,Surgery

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1. Avoiding Ring Avulsion Injuries With Silicone Rings: A Biomechanical Study;The Journal of Hand Surgery;2021-11

2. The Impact of Microsurgery on the Treatment of Ring Avulsion Injuries;Plastic & Reconstructive Surgery;2020-10-06

3. Revascularización y reimplante digital. Revisión de conceptos actuales;Revista Colombiana de Ortopedia y Traumatología;2020-10

4. Avulsion Injuries of the Hand and Wrist;RadioGraphics;2020-01

5. The Impact of Microsurgery on the Treatment of Ring Avulsion Injuries;Plastic and Reconstructive Surgery;2019-12

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