To the Editor:
A gentleman in his mid-40s presented with a left fourth finger injury to the medical team at the finish line of a 50-mile mountain bike race. He reported dislocation of his left fourth proximal interphalangeal joint (PIPJ) as a result of a fall during the race. He was able to self-reduce his finger immediately. Despite severe pain and swelling, he completed the race. On arrival to the medical station, there was no joint deformity, but he had significant edema of his fourth finger on examination, with a ring that was not removable. He was very tender over the PIPJ, and the neurovascular condition of the finger was intact. The ring was removed using a hand-powered ring cutter (Figure).
Removal of the trapped ring by a hand-powered ring cutter.
Finger injuries are among the most common musculoskeletal injuries in endurance athletes. If the injury happens while the athlete is wearing a ring, immediate removal of the ring is important to prevent constriction syndrome. 1 Most cases of digital constriction (tourniquet) syndromes occur in infants and mentally ill patients.2,3 Delay in presenting for medical attention may happen for a variety of reasons. 2 –4 Etiologies of digital tourniquet syndrome include external constricting bands (eg, metal, plastic, hair) and traumatic, infectious, endocrinologic, allergic, rheumatologic, and dermatologic conditions.1,2 Treatment of an acute edematous finger with a constricting ring requires urgent intervention. Neurovascular examination of the affected digit is important. The ring can be removed with less-invasive methods like distal lubrication (eg, soap, mineral oil, and lubricant gel), distal edema reduction (eg, elevation of the affected extremity, ice, compression of the distal area to the ring), sequential compression (eg, dental floss, sutures, elastic tapes, and string-wrap methods), and surgical glove method.1,5 If these methods are unavailable or unsuccessful, division of the constricting band is necessary.1,5 This can be achieved by a cutting tool or a saw (hand-powered or motorized). A hand-powered ring cutter is an easy-to-use tool that can be added to a medical bag as in our case.
Footnotes
Acknowledgment
The authors would like to thank Mr. George Gipson.