Review of techniques for the removal of trapped rings on fingers with a proposed new algorithm

Published:September 25, 2013DOI:


      Various removal techniques for rings trapped on the finger have been described in the current literature. However, despite this being a frequently encountered situation in emergency departments, there is no comprehensive algorithm to manage and follow these patients in the current literature. The purposes of this study were to describe the most commonly used ring removal techniques and to establish an algorithm for the removal of rings trapped on fingers. We performed a comprehensive literature search in several databases to identify all articles, case reports, letters, and book chapters that focus on ring removal techniques in English language from 1960 to the present. There are 2 methods of removal: (1) noncutting techniques in which the rings can be removed without breaking the integrity of the ring and (2) various ring-cutting equipments and tools. All these techniques are classified into distinct groups and described in detail with illustrations. Furthermore, an algorithm for handling such patients is established according to case-based patient care. Following an algorithm for the removal of trapped rings on the finger will be useful for patients and emergency physicians. It will also prevent possible complications and will save time.
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        • Lim B.H.
        • Tan B.K.
        • Peng Y.P.
        Digital replantations including fingertip and ring avulsion.
        Hand Clin. 2001; 17: 419-431
      1. Buttaravoli P. Minor emergencies. Chapter 152. 3rd ed. page 604.

      2. Tintinalli JE. Emergency medicine: a comprehensive study guide. Ring tourniquet syndrome. 6th ed. page 312.

        • Pfenninger John L.
        Pfenninger and Fowler's procedures for primary care: expert consult. Ring removal from an edematous finger.
        Chapter 31. 3rd Ed. 2010
        • Fuchs S.M.
        Ring removal.
        in: King C. Henretig F.M. Textbook of pediatric emergency procedures. 2nd ed. Lippincott Williams & Wilkins, Philadelphia2008
        • Bawden J.
        • Villa-Roel C.
        • Singh M.
        • Fabris G.
        • Bond K.
        • Boyko D.
        • et al.
        Procedural sedation and analgesia in a Canadian ED: a time-in-motion study.
        Am J Emerg Med. 2011; 29: 1083-1088
        • Bahn E.L.
        • Holt K.R.
        Procedural sedation and analgesia: a review and new concepts.
        Emerg Med Clin North Am. 2005; 23: 503-517
        • Venters W.B.
        Ring removal from a swollen finger: a refined technique.
        J Surg Orthop Adv. 2006; 15: 181-183
        • Uygur F.
        • Özyurt M.
        • Evinç R.
        • Hosbul T.
        • Çeliköz B.
        • Haznedaroglu T.
        Comparison of octenidine dihydrochloride (Octenisept®), polihexanide (Prontosan®) and povidon iodine (Betadine®) for topical antibacterial effects in Pseudomonas aeruginosa–contaminated, full-skin thickness burn wounds in rats.
        Central European Journal of Medicine. 2008; 3: 417-421
        • Advisory Committee on Immunization Practices
        Recommended adult immunization schedule: United States, 2012.
        Ann Intern Med. 2012; 156: 211
      3. Wound management and tetanus prophylaxis.
        • Witz R.
        Ring removal.
        Nurse Pract. 2002; 27: 54
        • Barnett R.C.
        Roberts J.R. Hedges J.R. Soft tissue foreign body removal. Clinical procedure in emergency medicine. WB Saunders, Philadelphia1993: 588-590
        • Mizrai S.
        • Lunski I.
        A simplified method for ring removal from an edematous finger.
        Am J Surg. 1986; 151: 412-413
        • Manca D.
        Practice tips. Ring and string.
        Can Fam Physician. 1997; 43: 859
        • Thilagarajah M.
        An improved method of ring removal.
        J Hand Surg [Br]. 1999; 24: 118-119
        • McElfresh E.C.
        • Peterson-Elijah R.C.
        Removal of a tight ring by the rubber band.
        J Hand Surg [Br]. 1991; 16: 225-226
        • Hiew L.Y.
        • Juma A.
        A novel method of ring removal from a swollen finger.
        Br J Plast Surg. 2000; 53: 173-174
        • Chiu T.F.
        • Chu S.J.
        • Chen S.G.
        • Chen S.L.
        • Chen T.M.
        Use of a Penrose drain to remove an entrapped ring from a finger under emergent conditions.
        Am J Emerg Med. 2007; 25: 722-723
      4. Kates SL. A novel method of ring removal from the aging finger. Geriatric Orthopaedic Surgery & Rehabilitation 2010:1;78–79.

        • Cresap C.R.
        Removal of a hardened steel ring from an extremely swollen finger.
        Am J Emerg Med. 1995; 13: 318-320
        • Nancarrow J.D.
        A simple technique for removing stubborn rings prior to hand surgery.
        J Hand Surg. 1993; 18: 544
        • Shah A.
        • Asirvatham A.
        • Ellis R.D.
        An improved technique for creating a digital tourniquet.
        Orthopaedic Rev. 1992; 11: 91-92
        • Clarke A.C.
        • Spencer R.F.
        Ring removal from the injured or swollen finger.
        J R Coll Surg Edinb. 1991; 36: 59
        • St Laurent C.
        The caterpillar technique for removal of a tight ring.
        Anesth Analg. 2006; 103: 1060-1061
        • Burbridge M.T.
        • Ritter S.E.
        An alternative method to remove a ring from an edematous finger.
        Am J Emerg Med. 2009; 27: 1165-1166
        • Chandra A.
        • Muchedzi T.
        Ujuzi: ring removal: a critical emergency procedure: (Practical Pearl/Perle Pratique).
        African J Emerg Med. 2012; 2: 127-128
        • Inoue S.
        • Akazawa S.
        • Fukuda H.
        • Shimizu R.
        Another simple method for ring removal.
        Anesthesiology. 1995; 83: 1133-1134
        • Mullett S.T.
        Ring removal from the oedematous finger. An alternative method.
        J Hand Surg [Br]. 1995; 20: 49
        • Kapickis M.
        • Kutz J.E.
        Titanium alloy ring crush injury.
        Am J Emerg Med. 2007; 25: 1084.e3-1084.e5
        • Allen K.A.
        • Rizzo M.
        • Sadosty A.T.
        A method for the removal of tungsten carbide rings.
        J Emerg Med. 2012; 43: 93-96
        • Ricks R.
        Removal of a tungsten carbide wedding ring with a diamond tipped dental drill.
        J Plast Reconstr Aesthet Surg. 2010; 63: 701-702
        • Shafiroff B.B.
        Easy removal of a partially embedded ring from a finger.
        Plast Reconstr Surg. 1979; 63: 841-842
        • Woodburn B.
        Ring removal.
        Can J Rural Med. 2010; 15: 167
        • Brock S.
        • Kuhn W.
        Removal of constricting bands using the Dremel drill.
        Acad Emerg Med. 1999; 6: 1182-1183
        • Greenspan L.
        Tourniquet syndrome caused by metallic bands: a new tool for removal.
        Ann Emerg Med. 1982; 11: 375-378
        • Louw J.
        • Hodsgon E.
        An unconventional ring removal tecnique for hard-to-remove rings.
        African journal of Emergency Medicine. 2012; 2: 81-83
        • Bleibleh S.
        • Childs J.
        • Baqai N.
        Removal of a titanium alloy ring.
        Br J Hosp Med. 2011; 72: 529
        • Fasano Jr., F.J.
        • Hansen R.H.
        Foreign body granuloma and synovitis of the finger: a hazard of ring removal by the sawing technique.
        J Hand Surg [Am]. 1987; 12: 621-623
        • Baker A.
        • Rylance K.
        • Giles S.
        The occasional ring removal.
        Can J Rural Med. 2010; 15: 26-28
        • Rubman M.H.
        • Taylor K.
        A rapid method for emergency ring removal.
        Am J Orthop. 1996; 25: 42-44
        • Zeng B.W.
        • Guo Y.J.
        • Huang C.C.
        Embedded ring injury of the middle finger in an amphetamine abuser.
        J Chin Med Assoc. 2006; 69: 95-97
        • Taylor S.P.
        • Boyd M.J.
        Unusually difficult ring removal from a finger solved using a dental instrument.
        Emerg Med Australas. 2005; 17: 285-287
        • Chambers A.F.
        • Harper A.
        Removal of a titanium ring using a dental saw.
        J Plast Reconstr Aesthet Surg. 2012; 65: 128-129
        • Sazwan R.S.
        • Anas A.H.
        • Nazer B.
        • Hashairi F.
        • Shaik Farid A.W.
        • Abu Yazid M.N.
        The use of dental drill in removing entrapped finger by metal ring in emergency department.
        Med J Malaysia. 2012; 67: 349-350
        • Palmer A.K.
        Complications from tourniquet use.
        Hand Clin. 1986; 2: 301-305