Stuck objects on fingers: pattern seen in a Nigerian teaching hospital and technique for removal

Introduction

An ordinary ring can get stuck on a finger if it has been worn for a long time. This is most often due to swelling of the finger. Different techniques have been described for removal of such rings but when the finger is grossly swollen and the ring is very thick or a band, these methods are not successful (1, 2).

From January 1994 to January 2011, 33 patients who had stuck objects on their fingers were treated at the Accident and Emergency Department, Usmanu  Danfodiyo University Teaching Hospital, Sokoto, Nigeria (Figure 1). Some of the objects were rings. The rest were nuts, washers (width between 0.8 and 1cm; thickness between 0.5 and 0.7cm) and plastic bands.  The patients were healthy children and mentally ill adults.  In women the preferred finger on which these objects were worn was the left ring finger. In children and men there was no preferred finger. The youngest and oldest patients were 5 and 64 years respectively. Most were women. Mean age of the patients was 34.2 (+.5) years. The male to female ratio was 1:5. There was no gangrene of any of the fingers at presentation.

 

Figure 1. Object stuck on adult’s finger. Before and after removal

 

The technique for removal

Usual ring cutters cannot cut these objects. The preferred instruments are technician’s instruments that are easily available – see Figure 2. The screw driver without a handle is inserted between the ring and the finger. This prevents further injury to the finger during cutting of the object with the junior hack saw. The object is cut at two spots along its circumference. After cutting the first spot on the ring, the wire cutters are used to widen the gap created on the ring. This widens the circumference of the ring. Further cutting of the ring at another spot removes an arc. The space created is usually wide enough for the ring to slip off. Wide bands are easily cut with a pair of wire strippers.

 

Figure 2. Technician’s instruments for removing objects stuck on fingers (from left to right: screw driver without a handle, wire stripers, wire cutters and a junior hack saw).

Result

Only manual instruments are safe for the removal of these objects because powered drills generate a lot of heat and can burn the finger and further compromise the circulation. Ischaemia of the fingers resolved after healing of the pressure sores (Figure 1) on the proximal phalanges. The microorganism isolated from the pressure sores was Staphylococcus aureus and most sensitive to ciprofloxacin. There was deficiency in movement in all the joints of the finger after healing of the pressure sores and flexion was initially painful. This resolved with time.

Conclusion

These types of patients have a poor sense of judgment and those who take care of them should always be attentive to what is worn on their fingers.  Cheap expansible rings can be given to them. Children can be trained to avoid wearing tight objects over their fingers. None of the patients ever had an object stuck again on the finger.

References

  1. WikiHow: How to remove a stuck ring. http://www.wikihow.com/Remove-a-Stuck-Ring  (browsed 18/11/2011).
  2. Harvard Medical School Family Health Guide. http://www.health.harvard.edu/fhg/firstaid/ring.shtml (browsed 18/11/2011). 

 

Photographs are the property of the author.