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A ring burn - electric or contact?
Bums (1990),
16, 69-70
69
Printedin Great Britain
A ring burn - electric or contact? M. F. Attalla, S. El-Ekiabi and A. Al-Baker Plastic Surgery and Bums Unit, Hamad Medical Corporation,
A circumferen~iul band of deep burn afiecting fhe ring finger sustained by a car electrician is presented. Although if was caused by short circuiting car battery by a metal spannerand the ring he was wearing,
the theinjury was
purely a contact bum.
Case report A Jo-year-old car electrician was referred to the Bums Clinic of Hamad Medical Corporation, Doha suffering from a small circumferential band of deep electrical injury to his right ring finger. While he was attempting to tighten the bolt on the positive pole of a 12-V car battery using a metal spanner, the stainless-steel ring on his ring finger touched the metal frame of the car. A short circuit was created through the ring. He felt a snaping pain in his finger, but no electric shock in his hand. He managed to remove the ring with some lubricating oil and noticed a band of
Doha, State of Qatar
discoloured skin in its place. No immediate treatment or action was taken until he noticed marked swelling of the ring finger with slight numbness. When seen 24 h later the ring finger was oedematous and a full skin thickness, a-mm wide well-demarcated circumferential bum at the base of the finger was noticed. There was marked anaesthesia of the whole digit distal to the injury with sluggish capillary filling in the nail-bed in spite of palpable digital pulsations. There were small patches of superficial bums on the adjacent sides of the little and long fingers with which the ring had been in contact. No other bums were detected in his hand or elsewhere. Immediate lateral escharotomy was carried out in the clinic. The condition of the digit improved gradually (Figwe 7) and the band of full skin thickness loss was grafted after 12 days. He had full functional recovery with no residual neurological or vascular changes. On examination of the stainless-steel ring two well-demarcated points of contact were seen with evident melting of the metal in both.
Figure 1. a,b Full skin thickness well-circumscribed circumferential bum on the right ring finger 10 days after the accident. Arrows indicate the two contact points on the stainless-steel ring worn at the time of the accident. 1990 Butterworth 0305-4179/90/010069-02
0
& Co (Publishers) Ltd
Bums(l990)Vol.16/No.l
70
which at least reached the point of melting of the stainless steel - not less than 900°C. It is evident that the electric current did not pass through the patients’ hand or finger and the injury is only a contact bum from the heated ring. The neurovascular changes were due to the circumferential deep bum and the resulting tourniquet effect. The mechanism of the bum and the resulting injury in the case reported by Fisher and Dvoretzley and our own patient do not comply with any of the categories laid down by Esses and Peters (1981), namely flash, arc and true electric bums. The significance of this bum cannot be overemphasized as it may result in more serious sequelae. More explanatory instructions from car battery manufacturers may be necessary to warn against wearing any metal conductors when manipulating a battery.
Figure 2. Diagrammatic illustration of the probable path of the electric current causing heating of the ring and the contact bum.
Discussion Fisher and Dvoretzley (1976) reported a similar case of a bum caused by a bracelet which they referred to as electrical injury. The circumstances of the accident indicate that the current passed from the positive pole of the battery, through the spanner, then the stainless-steel ring to the earthed car frame. The highest electrical resistance in this path was that of the ring with the resultant creation of the intense heat
References Esses S. I. and Peters W. J. (1981) Electric bums; pathophysiology and complications. Can. J. kg. 24,Il. Fisher B. K. and Dvoretzley I. (1976) Bracelet burn - an unusual
electric bum. Hand 8,158. Paper accepted
4 July 1989.
CorrespondenceshouM be aalfressedto: Mr M. F. Attalla, PO Box 3050, Doha, Qatar.
16, 69-70
69
Printedin Great Britain
A ring burn - electric or contact? M. F. Attalla, S. El-Ekiabi and A. Al-Baker Plastic Surgery and Bums Unit, Hamad Medical Corporation,
A circumferen~iul band of deep burn afiecting fhe ring finger sustained by a car electrician is presented. Although if was caused by short circuiting car battery by a metal spannerand the ring he was wearing,
the theinjury was
purely a contact bum.
Case report A Jo-year-old car electrician was referred to the Bums Clinic of Hamad Medical Corporation, Doha suffering from a small circumferential band of deep electrical injury to his right ring finger. While he was attempting to tighten the bolt on the positive pole of a 12-V car battery using a metal spanner, the stainless-steel ring on his ring finger touched the metal frame of the car. A short circuit was created through the ring. He felt a snaping pain in his finger, but no electric shock in his hand. He managed to remove the ring with some lubricating oil and noticed a band of
Doha, State of Qatar
discoloured skin in its place. No immediate treatment or action was taken until he noticed marked swelling of the ring finger with slight numbness. When seen 24 h later the ring finger was oedematous and a full skin thickness, a-mm wide well-demarcated circumferential bum at the base of the finger was noticed. There was marked anaesthesia of the whole digit distal to the injury with sluggish capillary filling in the nail-bed in spite of palpable digital pulsations. There were small patches of superficial bums on the adjacent sides of the little and long fingers with which the ring had been in contact. No other bums were detected in his hand or elsewhere. Immediate lateral escharotomy was carried out in the clinic. The condition of the digit improved gradually (Figwe 7) and the band of full skin thickness loss was grafted after 12 days. He had full functional recovery with no residual neurological or vascular changes. On examination of the stainless-steel ring two well-demarcated points of contact were seen with evident melting of the metal in both.
Figure 1. a,b Full skin thickness well-circumscribed circumferential bum on the right ring finger 10 days after the accident. Arrows indicate the two contact points on the stainless-steel ring worn at the time of the accident. 1990 Butterworth 0305-4179/90/010069-02
0
& Co (Publishers) Ltd
Bums(l990)Vol.16/No.l
70
which at least reached the point of melting of the stainless steel - not less than 900°C. It is evident that the electric current did not pass through the patients’ hand or finger and the injury is only a contact bum from the heated ring. The neurovascular changes were due to the circumferential deep bum and the resulting tourniquet effect. The mechanism of the bum and the resulting injury in the case reported by Fisher and Dvoretzley and our own patient do not comply with any of the categories laid down by Esses and Peters (1981), namely flash, arc and true electric bums. The significance of this bum cannot be overemphasized as it may result in more serious sequelae. More explanatory instructions from car battery manufacturers may be necessary to warn against wearing any metal conductors when manipulating a battery.
Figure 2. Diagrammatic illustration of the probable path of the electric current causing heating of the ring and the contact bum.
Discussion Fisher and Dvoretzley (1976) reported a similar case of a bum caused by a bracelet which they referred to as electrical injury. The circumstances of the accident indicate that the current passed from the positive pole of the battery, through the spanner, then the stainless-steel ring to the earthed car frame. The highest electrical resistance in this path was that of the ring with the resultant creation of the intense heat
References Esses S. I. and Peters W. J. (1981) Electric bums; pathophysiology and complications. Can. J. kg. 24,Il. Fisher B. K. and Dvoretzley I. (1976) Bracelet burn - an unusual
electric bum. Hand 8,158. Paper accepted
4 July 1989.
CorrespondenceshouM be aalfressedto: Mr M. F. Attalla, PO Box 3050, Doha, Qatar.