Abstract
A ring is traditionally worn as a symbol of love and affection or as decorative ornamental jewellery. However, rings are not without risk. The spectrum of danger can range from debilitating avulsion injuries to simple contact dermatitis. Unknown to many, an unusual rarity exists; previous authors have termed this entity ‘embedded ring syndrome’. We sought to review the literature and collate evidence on the common features of this syndrome.A literature review was performed on cases reported from 1947 to 2017 accessed through the healthcare database advanced search (HDAS). A total of 28 cases were analysed for demographics, symptomatology and operative techniques. Overall, 64.3% were females, and 50% had a psychiatric comorbidity. There was a causative event preceding the injury in 35.7% of cases; 71.4% had a reduced range of movement or reported a stiff finger and 32.1% had reduced sensation. The majority of patients underwent ring removal and primary closure, without documentation as to whether neurovascular bundles and tendons were visualised. Embedded ring injuries are rare. Consequently, information is sparsely available regarding its natural history and management. The hand surgeon’s approach requires an understanding that the chronicity of these injuries can have a significant traumatic impact on the structures of the finger.
Highlights
BackgroundIt is believed that ancient Egyptians first established the custom of ring bearing to reflect the eternity of their marriage: impervious and unbroken
There was a causative event preceding the injury in 35.7% of cases; 71.4% had a reduced range of movement or reported a stiff finger and 32.1% had reduced sensation
An embedded ring can be seen as the re-epithelialisation of skin over any part of the ring resulting in the formation of a skin bridge
Summary
It is believed that ancient Egyptians first established the custom of ring bearing to reflect the eternity of their marriage: impervious and unbroken. There are well-established methods for entrapped ring removal in the emergency department such as the winding technique, which uses thread to compress the finger, or using manual ring cutters to saw the ring [3] They can result in complex traumatic avulsion injuries to the hand when the ring is caught on an object and forcefully pulled. The following search terms were used: ‘embedded ring injury/injuries’ or ‘ring injury/injuries’ or ‘embedded ring syndrome’ both independently and combined with ‘ulceration’ ‘erosion’ ‘digit’ ‘finger’ or ‘retained.’ Articles were included for patients of any age range and demographic Excluded articles were those that described ring injuries without any epithelialisation/’skin bridge’ over the ring, articles relating to ring entrapment rather than embedded rings and articles not written in English text.
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