Prevention of Ring finger avulsion

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Prevention of Ring finger avulsion

• T. Dubert
• Paris
• France

2
References

• Author Year Nbre of cases devasc Contry Perio
  d
• Crawford 1952 7 57 USA
• Davalli 1959 12 Italy 12 years
• Bevin 1963 4 100 USA
• Kinmonth 1964 1 per year 100
• Thompson 1968 24 USA
• Bianchi 1969 16 100 Italy 11 years
• Alonso Artieda1971 1 100 Spain
• Chase 1971 1 100 USA
• Carroll 1974 100 90 USA 20 years
• Flagg 1977 2 100 USA
• Hougaard 1986 14 85 Danemark 10 years
• Tampieri 1988 2 100 Italy
• Weil 1989 16 53 USA 10
• Urbaniak 1981 24 USA 5 years
• Weeks 1982 1 100 USA
• Nissenbaum 1984 17 88 USA 6 years
• Tsai 1984 12 100 USA 10 years

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Mechanism of the accidentCatching the ring on
a fixed object while falling or jumping
30 are occupational accidents 70 of the
accidents occur in every day activities
30 to 49 yo  Regular  wedding rings Women
30 Men 60
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Mechanism of the accidentCatching the ring on
a fixed object while falling or jumping

• Jumping from a moving vehicle
• Catching on a -pole or fence post
• A moving belt or other moving object
• On a nail
• slipping off a ladder or a tree
• Hanging up keys on a hook
• Shutting a door
• Jumping into the water from a pier
• Diving from a boat
• Attaching a goal-post nets
• Jammed in an antiaircraft machinegun

13 à 15 of all finger amputations
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Mechanism of the accident
6
Mechanism of the accident
The ring is caught... and forces the soft
tissues to tear Amputation is frequent
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Epidemiology
200 to 350 cases per year for a 60.106
population1 case per day in France 5
cases per day in Europe 25 (300.106
population)
Bianchi et al 1969 Carrol 1974 Davalli et
Zarotti 1959 Holst-Nielsen 1980 Kinmonth
1964
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Consequences for the patient and the community

• Functional disability
• Cosmetic impairment
• Financial compensation

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Kay- 1989

• I - Circulation adequate, with or without
  skeletal injury
• II - Circulation inadequate
• without skeletal injury
• III - Circulation inadequate
• with fracture or joint injury
• IV - Complete amputation

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• Indication depends mainly
• on the
• Amputation level
• ABOVE FDS insertion - REPLANTATION
• BELOW FDS insertion - NO REPLANTATION

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Prevention

•  The present day use of a finger ring frequently
  becomes as dangerous as the poison rings of the
  romans .

Bevin , 1963
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Prevention

•  Should it be found to be mandatory to use a
  ring , serious thought should be given to
  modifying it so that this severe injury does not
  result in a tragedy .
• Carrol, 1974

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Prevention
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Mechanism of the accident

• Wedding rings
• Thin
• Sharp
• Too big

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Prevention
Carroll 1974, Davalli and Zarotti
1959, Flagg et al 1977, Mitz
1994,Scerri and Ratcliffe 1994, Thompson et
al 1968
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Existing prevention devices ?

• Weak point
• (Bianchi et al 1969, Varela
  1996)unacceptable because visible
• and no biomechnical experimentation

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Prevention device

• Unvisible
• Sparing continuity of the ring
• Thresholds of finger resistance
• Thresholds of the ring opening
• Controls in cadaveric specimens

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Many devices have been tested
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High speed traction tests
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The  Adlife  System!
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Thresholds of finger resistance/Adlife rings
Laboratoire danatomie de la Faculté de
Médecine des Saints Pères
Ecole Nationale d Arts Métiers
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High speed traction tests

• Skin treshold 5 Kg falling from a 50 cm
  height

23
Controls in cadaveric specimens
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4 to 5 Kg No severe lesion
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6 à 8 Kg 1 severe lesion / 21
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gt9 Kg severe lesion 7/12
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With a regular ring
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With the preventive Adlife device
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Traction tests at low speed

• F start F max
• Test 2 260 N 450 NAge 90 ans

46 after 70 yo
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 Adlife  rings open before skin lesion

• 305 N (test 6)

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The key element is the skin

• Skin resistance
• Palmar skin 2.5 Kg/mm
• Dorsal skin 1 Kg/ mm
• Skin opens between 260 N and 670 N
• Average 350 N

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Thresholds of the ring opening
Laboratoire National dessaisRapport de
recherche B 012 897
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Thresholds of the ring opening
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Threshold of ring opening
Benign lesions
Severe lesions
Traction load
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Reliability of Adlife device
140 tests
Adlife
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US patent
European and international patent
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Adlife
Continuity is preserved
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RELIABLE and UNDETECTABLE

• The continuity is preserved
• No loss of the quantity or quality of gold
• There is no opening or hollow
• Preservation of the symbolic value
• Industrial gauging of the resistance.

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Scientific publication An experimental study of
ring avulsion injuries and two preventive
devices Th. Dubert, A.Diop PhD, P.Voeltzel . J
Hand Surgery ,2000, 25B 5 418-421.Oral
presentations 4 Non scientific
publications News paper 18 Radio-Television 7
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Government Recommandation
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Prevention bill
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Conclusion

• A well defined problem
• A technical solution simple and reliable
• Potentially high commercial benefits
• One cause of failure Prevention is not
  commercially efficient A legal obligation
  could not be obtained