1
|
Jewett CA, Uppuganti S, Desai MJ. Avoiding Ring Avulsion Injuries With Silicone Rings: A Biomechanical Study. J Hand Surg Am 2021; 46:1030.e1-1030.e5. [PMID: 34001410 DOI: 10.1016/j.jhsa.2021.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 12/10/2020] [Accepted: 02/22/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Finger avulsion injuries account for 5% of upper extremity injuries requiring evaluation in an emergency room. They are devastating injuries that require microvascular reconstruction or amputation. As public awareness rises, there is a growing market for silicone rings, with limited data on their ability to prevent ring avulsion injuries. METHODS Five cadaver forearms were attached to a custom fixture, allowing for ring avulsion simulations. Specifically designed silicone or metal rings of varying sizes (#4-#11) were assigned to one of five fingers on each forearm, based on fit. The contralateral corresponding finger was tested using a ring of the same size in the other material. A preload of 2 N was applied to each ring, and ultimate failure force was determined by applying an upward force at a loading rate of 500 mm/sec until failure. Additionally, a fifth cadaver forearm was used to determine the ultimate failure force of silicone rings in a clenched fist position. RESULTS The average ultimate failure force for silicone rings of all sizes was 53.0 N, compared to 495.2 N for metal rings of all sizes. The average ultimate failure force of silicone rings in the clenched fist position was increased across rings of all sizes, with an average of 99.9 N. There were no degloving injuries in the silicone ring avulsion group. CONCLUSIONS Biomechanically, silicone rings have a significantly lower failure force than metal rings and may help prevent ring avulsion injuries. CLINICAL RELEVANCE The use of silicone rings should be encouraged in professions where ring avulsion injuries are more likely, such as heavy labor.
Collapse
Affiliation(s)
- Callie A Jewett
- Department of Orthopaedic Surgery Vanderbilt University Medical Center, Nashville, TN.
| | | | - Mihir J Desai
- Division of Hand and Upper Extremity, Department of Orthopaedic Surgery at Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|
4
|
Weintraub MD, Hansford BG, Stilwill SE, Allen H, Leake RL, Hanrahan CJ, Chan BY, Soltanolkotabi M, Kobes P, Mills MK. Avulsion Injuries of the Hand and Wrist. Radiographics 2020; 40:163-180. [DOI: 10.1148/rg.2020190085] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Michael D. Weintraub
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
| | - Barry G. Hansford
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
| | - Sarah E. Stilwill
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
| | - Hailey Allen
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
| | - Richard L. Leake
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
| | - Christopher J. Hanrahan
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
| | - Brian Y. Chan
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
| | - Maryam Soltanolkotabi
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
| | - Patrick Kobes
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
| | - Megan K. Mills
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
| |
Collapse
|
6
|
Kerschhagl M, Larcher L, Mattiassich G, Prantl L. Replantation of a circumferentially degloved thumb in an occupational crush injury – A case report and review of the literature. Clin Hemorheol Microcirc 2019; 71:403-414. [DOI: 10.3233/ch-199004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- M. Kerschhagl
- Traumacenter Linz, Teaching Hospital of the Paracelsus Medical University Salzburg, Linz, Austria
| | - L. Larcher
- Plastic, Aesthetic and Reconstructive Surgery Sanitaetsbetrieb South Tyrol (SABES), Bolzano, Italy
| | - G. Mattiassich
- Traumacenter Styria, Teaching Hospital of the Medical University Graz, Graz, Austria
| | - L. Prantl
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| |
Collapse
|
7
|
Ju J, Li L, Hou R. Transplantation of a Free Vascularized Joint Flap from the Second Toe for the Acute Reconstruction of Defects in the Thumb and other Fingers. Indian J Orthop 2019; 53:357-365. [PMID: 30967709 PMCID: PMC6415561 DOI: 10.4103/ortho.ijortho_200_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study aimed to evaluate a novel surgical method for the acute reconstruction of defects in the thumb and other fingers by transplanting a free vascularized joint flap from the second toe and to determine its clinical curative effects. MATERIALS AND METHODS A free vascularized joint flap from the second toe was transplanted to reconstruct a complete defect of the thumb and other fingers accompanied by the loss of the proximal finger in 10 patients. Of these patients, three had their thumbs reconstructed with a free vascularized joint flap from the second toe and with the proximal interphalangeal joint flap, one had a thumb reconstructed with a free vascularized joint flap from the second toe, and six had their finger defects reconstructed with the proximal interphalangeal joint flap. The toes of the metatarsophalangeal joint were amputated at the foot donor site. All patients underwent one-stage emergency surgery. RESULTS The composite tissue flaps, replanted thumbs, and fingers survived well in all 10 cases. Follow-up visits were conducted for 6-28 months, with an average of 9 months of follow-up. The transplanted bone joints healed over a period of 6-16 weeks. Bone nonunions and refractures did not occur, and the walking function of the foot donor site was not visibly affected. CONCLUSION A free vascularized joint flap from the second toe can be transplanted to repair defects in the thumb and other fingers. This technique can be applied to recover the appearance and function of fingers.
Collapse
Affiliation(s)
- Jihui Ju
- Department of Orthopaedics, Ruihua Affiliated Hospital of Soochow University, Suzhou, China
| | - Lei Li
- Department of Orthopaedics, Ruihua Affiliated Hospital of Soochow University, Suzhou, China
| | - Ruixing Hou
- Department of Orthopaedics, Ruihua Affiliated Hospital of Soochow University, Suzhou, China,Address for correspondence: Dr. Ruixing Hou, Department of Orthopaedics, Ruihua Affiliated Hospital of Soochow University, No. 5 Tayun Road, Wuzhong District, Suzhou 215104, China. E-mail:
| |
Collapse
|
8
|
Calderazzi F, Menozzi M, Nosenzo A, Galavotti C, Pogliacomi F, Ceccarelli F. Single ray amputation in traumatic injury of the hand: review of literature. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 90:14-23. [PMID: 30714994 PMCID: PMC6503410 DOI: 10.23750/abm.v90i1-s.7677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 09/25/2018] [Indexed: 11/23/2022]
Abstract
Background and aim of the work: Ring avulsion are relatively common hand lesions and are associated with significant disability, especially in hand-workers. The treatment choice is still debatable. We sought to conduct a detailed systematic review in attempt to collate evidence on functional, cosmetic and patient-reported outcomes (PROs) following ray amputation for the management of traumatic hand injury and ring avulsion injury. Methods: Using the PubMed database we made a systematic search for articles regarding single ray amputation after traumatic hand lesion. Nine articles met our including criteria and were analysed. Results: Most of the included studies suggest that for those worse cases ray amputation still represent a good option. Indeed ray resection can eliminate the gap, remove a cumbersome or painful digit and guarantes better cosmesis but reduces grip and pinch strength (from 15% to 30%) and decreased palm width. Conclusions: Different surgical techniques are available, almost all of them results in a loss of strength but ensure good both functional and cosmetic results. (www.actabiomedica.it)
Collapse
Affiliation(s)
- Filippo Calderazzi
- Dipartimento Scienze Chirurgiche Ospedale Maggiore Parma, U.O. Clinica Ortopedica.
| | | | | | | | | | | |
Collapse
|
9
|
Abstract
BACKGROUND Ring avulsion injuries can range from soft tissue injury to complete amputation. Grading systems have been developed to guide treatment, but there is controversy with high-grade injuries. Traditionally, advanced ring injuries have been treated with completion amputation, but there is evidence that severe ring injuries can be salvaged. The purpose of this systematic review was to pool the current published data on ring injuries. METHODS A systematic review of the English literature published from 1980 to 2015 in PubMed and MEDLINE databases was conducted to identify patients who underwent treatment for ring avulsion injuries. RESULTS Twenty studies of ring avulsion injuries met the inclusion criteria. There were a total of 572 patients reported with ring avulsion injuries. The Urbaniak class breakdown was class I (54 patients), class II (204 patients), and class III (314 patients). The average total arc of motion (TAM) for patients with a class I injury was 201.25 (n = 40). The average 2-point discrimination was 5.6 (n = 10). The average TAM for patients with a class II injury undergoing microsurgical revascularization was 187.0 (n = 114), and the average 2-point discrimination was 8.3 (n = 40). The average TAM for patients with a class III injury undergoing microsurgical revascularization was 168.2 (n = 170), and the average 2-point discrimination was 10.5 (n = 97). CONCLUSIONS Ring avulsion injuries are commonly classified with the Urbaniak class system. Outcomes are superior for class I and II injuries, and there are select class III injuries that can be treated with replantation. Shared decision making with patients is imperative to determine whether replantation is appropriate.
Collapse
Affiliation(s)
- Ravinder Bamba
- Vanderbilt University, Nashville, TN, USA,Georgetown University, Washington, DC, USA,Ravinder Bamba, Department of Plastic Surgery, Vanderbilt University Medical Center, Vanderbilt University, 1121 21st Avenue S, S-2221, Nashville, TN 37232-2345, USA.
| | | | | | | | | |
Collapse
|