Prevention of Ring finger avulsion

T. Dubert

Paris

France

2

References Author Year Nbre of cases % devasc Contry Period

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 Sturzenegger 1988 25 78 Switzeland 9 years Hung 1989 2 100 Hong Kong Kay 1989 55 95 UK 9 years Beris 1994 14 92 Greece 9 years Varela 1996 2 100 USA/Croatie Van der Horst1989 48 100 Netherlands 5 years 1/2

3

Mechanism of the accident:

Catching 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 %

4

Mechanism of the accident:

Catching 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

machinegun13 à 15 % of all finger amputations

5

Mechanism of the accident

6

Mechanism of the accident

The ring is caught...

… and forces the soft tissues to tearAmputation is frequent

7

Epidemiology

200 to 350 cases per year for a 60.106 population

1 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

8

Functional disability

Cosmetic impairment

Financial compensation

Consequences for the patient and the community

9

Kay- 1989

I - Circulation adequate, with or without skeletal injury

II - Circulation inadequatewithout skeletal injury

III - Circulation inadequatewith fracture or joint injury

IV - Complete amputation

10

Indication depends mainly

on the

Amputation level

ABOVE FDS insertion - REPLANTATION

BELOW FDS insertion - NO REPLANTATION

11

Prevention

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

Bevin , 1963

12

« 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

Prevention

13

Prevention

14

Mechanism of the accident:

Wedding rings Thin Sharp Too big

15

Prevention

Carroll 1974, Davalli and Zarotti 1959,

Flagg et al 1977, Mitz 1994,Scerri and Ratcliffe 1994,

Thompson et al 1968

16

Weak point (Bianchi et al 1969, Varela 1996)

unacceptable because visible and no biomechnical experimentation

Existing prevention devices ?

17

Prevention device

1. Unvisible

2. Sparing continuity of the ring

3. Thresholds of finger resistance

4. Thresholds of the ring opening

5. Controls in cadaveric specimens

Many devices have been tested

19

High speed traction tests

20

The « Adlife » System!

QuickTime™ et undécompresseur

sont requis pour visionner cette image.

Laboratoire d’anatomie de la

Faculté de Médecine des Saints Pères

Thresholds of finger resistance/Adlife rings

Ecole Nationale d’ Arts & Métiers

22

Skin treshold :

5 Kg falling from a 50 cm height

High speed traction tests

23

Controls in cadaveric specimens

24

4 to 5 Kg : No severe lesion

25

6 à 8 Kg : 1 severe lesion / 21

26

>9 Kg : severe lesion 7/12

27

With a regular ring

28

With the preventive Adlife device

29

Traction tests at low speed

F start F max Test 2 260 N 450 N

Age : 90 ans

46 % after 70 yo

30

• 305 N (test 6)

« Adlife » rings open before skin lesion

31

The key element is the skin

Skin resistancePalmar skin : 2.5 Kg/mmDorsal skin : 1 Kg/ mm

Skin opens between : 260 N and 670

N

Average 350 N

32

Laboratoire National d’essaisRapport de recherche B 012 897

Thresholds of the ring opening

33

Thresholds of the ring opening

Traction load

Threshold of ring opening

Benign lesions

Severe lesions

35

Reliability of Adlife device

Low speed High speed

Opening threshold

350 N < 5 Kg

Severe lesions 0 0

Adlife140 tests

36

US patent

European and international patent

37

Adlife

Continuity is preserved

38

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.

39

40

Scientific publicationAn experimental study of ring avulsion injuries and two preventive devicesTh. Dubert, A.Diop PhD, P.Voeltzel .J Hand Surgery ,2000, 25B; : 5: 418-421.

Oral presentations 4

Non scientific publicationsNews paper 18Radio-Television 7

41

Government Recommandation

42

Prevention bill

43

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