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Removal of a tight ring by the rubber band technique
Technical Tips
Flexion gap measurement VERA BLAIR, from the Ulster Hospital, Belfast A wooden tongue depressoror spatula has proved to be a convenient means of monitoring the progression of a recovering flexion gap. The examiner or the patient places the end of the spatula in the distal palm crease. The finger under examination is then flexed through its maximal range of flexion and the point where the nail coincides with the spatula is marked with a ball-point pen. The date can be added to this mark and a target mark for the next attendance can be indicated by a dotted line. This provides an accurate measurementof flexion and also a record of progression. Two fingers can be recorded using both sides of the spatula, and by turning the spatula end-for-end four fingers can be recorded on the one spatula. The patient is instructed to bring the “flexion gap stick” to each subsequentreview and their new point of flexion is quickly marked, easily measuredand recorded. Accepted: 11 September 1990. V. Blair, Dip.C.O.T., Occupational
Therapist
Dept, The Ulster Hospital,
Dundonald,
finger with the ring is first lubricated with soap (or petroleum jelly). A rubber band 3 to 4 mm. wide is passed beneath the ring. A mosquito clamp can be used to help pass the rubber band beneath the ring. (Figs 1 and 2). After both loops of the rubber band protrude (Fig. 3), the surgeon then places his finger through the loops of the rubber band and the rubber band is then pulled distally, while moving the rubber band circumferentially around the ring and finger (Fig. 4), until the ring is removed. (Fig. 5).
Belfast
0 1991 The British Society for Surgery okthe Hand
Fig. 1 A mosquito clamp is passed under the ring and grasps the rubber band.
Removal of a tight ring by the rubber band technique E. C. McELFRESH and R. C. PETERSON-ELIJAH, from the St. Anthony Orthopaedic Clinic, St. Paul, Minnesota, U.S.A. Recently two techniques have been described to remove a tight ring on an injured hand. (Belliappa, 1989; Wee and Chandra, 1989).In addition, lubricating a finger that is not markedly swollen will facilitate manual removal. Another means of removing a tight ring is to use a commercial ring cutter. A ring may also be removed utilizing a rubber band if the injury is not an open wound of that digit or if the digit is not unstable due to a fracture or a ligament injury. The VOL.
16B No. 2 MAY
1991
Fig. 2
The rubber band is brought beneath the ring. 225
TECHNICAL
Fig. 3
The rubber band is placed with equal lengths of loop on each side of the ring.
TIPS
Fig. 4
The surgeon’s finger is placed through both loops of the rubber band and then pulled distally, while moving the rubber band circumferentially.
The technique usually works quite easily. It is faster than the wrapped suture or string technique and usually causes less trauma to the finger. Editor’s Note In the paper by Belliappa referred to above,it was said that the method “does not appearto have beendescribedin the surgicalliterature”. It has sincebeenbrought to our attention that it was in fact described by Flatt in his book “The Care of Minor Hand Injuries” (St. Louis, C. V. Mosby, 1959: pages256 and 257). It was not Dr. Flatt who told us, but Mr. Belliappa and I apologizeto him.
References BELLIAPPA, P. P. (1989). A technique for removal of a tight ring. Journal of Hand Surgery, 14B: 127. WEE, J. T. K. and CHANDRA, D. (1989).A rapid method of removal of rings impacted in fingers. Journal of Hand Surgery, 14B: 1: 126127.
Accepted 7.6 October 1990 CkZ~kElfresh, St. Antony Orthopedic
Fig. 5
226
The ring is removed from the finger.
Clinic, 1661 St. Anthony
Avenue, St. Paul, MN 55104
0 1991 The British Society for Surgery of the Hand
THE JOURNAL OF HAND SURGERY
Flexion gap measurement VERA BLAIR, from the Ulster Hospital, Belfast A wooden tongue depressoror spatula has proved to be a convenient means of monitoring the progression of a recovering flexion gap. The examiner or the patient places the end of the spatula in the distal palm crease. The finger under examination is then flexed through its maximal range of flexion and the point where the nail coincides with the spatula is marked with a ball-point pen. The date can be added to this mark and a target mark for the next attendance can be indicated by a dotted line. This provides an accurate measurementof flexion and also a record of progression. Two fingers can be recorded using both sides of the spatula, and by turning the spatula end-for-end four fingers can be recorded on the one spatula. The patient is instructed to bring the “flexion gap stick” to each subsequentreview and their new point of flexion is quickly marked, easily measuredand recorded. Accepted: 11 September 1990. V. Blair, Dip.C.O.T., Occupational
Therapist
Dept, The Ulster Hospital,
Dundonald,
finger with the ring is first lubricated with soap (or petroleum jelly). A rubber band 3 to 4 mm. wide is passed beneath the ring. A mosquito clamp can be used to help pass the rubber band beneath the ring. (Figs 1 and 2). After both loops of the rubber band protrude (Fig. 3), the surgeon then places his finger through the loops of the rubber band and the rubber band is then pulled distally, while moving the rubber band circumferentially around the ring and finger (Fig. 4), until the ring is removed. (Fig. 5).
Belfast
0 1991 The British Society for Surgery okthe Hand
Fig. 1 A mosquito clamp is passed under the ring and grasps the rubber band.
Removal of a tight ring by the rubber band technique E. C. McELFRESH and R. C. PETERSON-ELIJAH, from the St. Anthony Orthopaedic Clinic, St. Paul, Minnesota, U.S.A. Recently two techniques have been described to remove a tight ring on an injured hand. (Belliappa, 1989; Wee and Chandra, 1989).In addition, lubricating a finger that is not markedly swollen will facilitate manual removal. Another means of removing a tight ring is to use a commercial ring cutter. A ring may also be removed utilizing a rubber band if the injury is not an open wound of that digit or if the digit is not unstable due to a fracture or a ligament injury. The VOL.
16B No. 2 MAY
1991
Fig. 2
The rubber band is brought beneath the ring. 225
TECHNICAL
Fig. 3
The rubber band is placed with equal lengths of loop on each side of the ring.
TIPS
Fig. 4
The surgeon’s finger is placed through both loops of the rubber band and then pulled distally, while moving the rubber band circumferentially.
The technique usually works quite easily. It is faster than the wrapped suture or string technique and usually causes less trauma to the finger. Editor’s Note In the paper by Belliappa referred to above,it was said that the method “does not appearto have beendescribedin the surgicalliterature”. It has sincebeenbrought to our attention that it was in fact described by Flatt in his book “The Care of Minor Hand Injuries” (St. Louis, C. V. Mosby, 1959: pages256 and 257). It was not Dr. Flatt who told us, but Mr. Belliappa and I apologizeto him.
References BELLIAPPA, P. P. (1989). A technique for removal of a tight ring. Journal of Hand Surgery, 14B: 127. WEE, J. T. K. and CHANDRA, D. (1989).A rapid method of removal of rings impacted in fingers. Journal of Hand Surgery, 14B: 1: 126127.
Accepted 7.6 October 1990 CkZ~kElfresh, St. Antony Orthopedic
Fig. 5
226
The ring is removed from the finger.
Clinic, 1661 St. Anthony
Avenue, St. Paul, MN 55104
0 1991 The British Society for Surgery of the Hand
THE JOURNAL OF HAND SURGERY