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Dr
Patrick HOUVET/ F.I.H.S
What
is ring-finger ?
It
is about the direct blow of a finger due to a ring or similar
mechanism. The finger is gets trapped in a hook or a door hinge,
or by jumping over a wire edge. The ring either goes off the finger
or amputates the finger by traction.
The major feature about this injury is that an avulsion mechanism
occurs at the tissues level.
These tissues resist in different forms :
 nerves
are torn distally, and vascular rupture is proximal.
osseous
avulsion can occur at the proximal interphalangeal level (PI)
as well as at the Distal interphalangeal level (DI), or simply
limit to the skin cover, which is by far rare.
ADILFE :
respect for the wedding ring…
· an unaltered alloy
· respect for the continuity of the ring
· same amount of gold. Invisible system after polish
…..and of the finger
A patented invisible system that respects the symbolic value of
the wedding ring.
Which are the ring finger injuries ?
Usually the finger is completely extracted, the patient presents
with exposure of the base of the 4th finger, from which two phalanxes
come out.
The superficial flexor is still unaltered on the base of the second
phalanx and the vessels stop bleeding.
On the dorsal side, the extensor is partly damaged.
At the level of the residual skin cover, it is not unusual that
the superficial flexor has undergone avulsion.
In some cases, rupture occurs at the proximal interphalangeal
level. In other cases, the skin cover may be torn, with no osseous
fragments.
Vladimir
Mitz classified the injury into 5 stages :
Stage
O : skin scratch.
Stage I : skin injury, a flap or skin grafting is required.
Stage II : dorsal extraction of veins, microsurgery repair
is required.
Stage III : vein and artery devascularisation with osseous
devasculatisation, artery and vein surgical procedure is required.
Stage IV : complete extraction of the finger
Which
examinations should be performed ?
Posterio/anterior
radiograph of the damaged or amputated segment is helpful. It allows
to determine the level of amputation or fracture, and eventually,
if there is an osseous segment in the amputated fragment.
How
is it treated ?
Stage
IV injury presents more significant lesion.
Therapeutic strategy is as follows :
The
skin coverage allows the necessary time to be certain that blood
supply of the remaining skin fragment is satisfactory.
vessels
and nerves separate.
provided
that the joint cannot be kept, arthrodesis is required.
only the superficial flexor will be kept, if it has been decided
to perform arthrodesis of the distal interphalangeal.
the
two nerves will be repaired.
By-pass
is usually required to recover safe blood supply and a good quality
vessel.
repair
of veins will be performed through by-pass, eventually with the
use of a flap of an adjacent finger.
Which are the specific risks ?
Recovery
is related to the proportion of the amputated segment. In case of
favourable recover, the finger will present swelling during the
first weeks, and tumefaction for about 6 months.
Rehabilitation is initiated immediately, and around the 6th month,
satisfactory function will be regained depending on the local condition.
A number of complications may arise, usually related to vascular,
arterial or vein thrombosis.
Failure often occurs at an early stage - during the first 24 hours-
or between the 3rd and 5th day, due to a delayed venous thrombosis,
which may occur on day 4th.
Failure is inevitable, and amputation may be considered to avoid
complications such as infection.
In case of a short stump, or else a skin flap dressing, treatment
can be re-initiated. In case of hypermotivated patients, digit reconstruction
may be performed through a transfer from a foot toe.
Prevention involves wearing a flexible wedding ring, either locally
or by having an adequate material.
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