Rings and Things.

SavageGlow · #1 ● 02-03-2023, 11:30 PM

This case is out of the Cook Islands, which are in the South Pacific and very remote:

The patient presented to the health outpost with aching of her left ring finger (pain score 8 out of 10) and associated swelling localized to the proximal phalanx (PIP) (Figures 1-2).

The patient first noticed the swelling in her ring finger three days prior, after a 10-hour flight. Her vitals were within normal limits. On examination of the finger, there was significant edema and shallow ulceration with granulation tissue formation over the ring margin. There was no purulent drainage, fluctuance, or streaking redness. Distal sensation was intact with normal two-point discrimination. The finger was warm, with capillary refill time less than two seconds. She was unable to flex the finger distal to the metacarpophalangeal joint.

Elevation of the limb, ice pack application, and lubrication with traction were all attempted. String technique was attempted but was not tolerated by the patient. The available topical anesthetic was insufficient to control the pain associated with string compression. Ring or bolt cutters were unavailable. The patient consented to ring cutting as ring preservation was not a priority. A topical anesthetic gel was applied to the finger. Successful ring removal was accomplished with a high-speed dental handpiece as well as water and a steel spatula to protect the underlying tissue (Figure 3).

A course of oral antibiotics was prescribed and tetanus toxoid vaccination was prophylactically administered following the ring removal [1-3]. On post procedure examination, the digit had intact distal sensation, capillary refill time less than two seconds, and improved range of motion. The patient had a full recovery without any complications or loss of function upon follow-up at four weeks.