Equipment & Gear, Exclusives

A Novel Approach to Ring Removal: Compression Device

Figure 1: RingRescue™ Compression Device (CD) employed in this case series.

Abstract

The need to remove rings is a common occurrence in the emergency department to prevent ischemia of the involved digit. Ring removal indications include upper extremity trauma, infections, burns, envenomation and others. Clinicians have a variety of techniques available to attempt ring removal. Often these techniques are not successful and removal of the ring with a cutting device is necessary. This case series introduces a novel device that uses compression to reduce the impact of finger swelling on ring removal and allow removal without injury to the patient or damage to the ring.

Introduction

Emergency ring removal is a common situation encountered in a variety of clinical and non-clinical environments. Standard approaches include the use of lubricants or surfactants alone or in combination with other techniques to assist in removal. Cutting the ring is a last resort utilized only if other approaches have been unsuccessful. As a variety of metals have become popular for the production of rings, cases of rings resistant to cutting have become more frequent.1 This paper explores use of a novel compression device (CD) for ring removal. The RingRescue™ CD was employed in this convenience case series.

A CD uses circumferential compression to reduce swelling around a stuck ring. The device is used by placing it near, but not overtop, the offending ring, and then is inflated compressing the finger. The device is applied, and the hand elevated, for approximately five minutes. The device is then removed, and with a small amount of lubricant, the ring is removed.

This paper follows up on six individuals who had their ring removed with a CD system. Each individual verbally consented to being contacted at a later date during the visit that their ring was removed. At the outset of the follow-up contact, written consent was obtained, and each patient was interviewed using a standardized question set.

Case Descriptions

The following cases illustrate six separate instances of successful removal of a ring using the CD.

Case 1: Ms. A: 79-year-old female with metastatic cancer.

Figure 2: Case 1 – Ring Removal Before & After

Ms. A was a 79-year-old female who was admitted to hospital in the winter with a recurrence of breast cancer and metastases causing a large bowel obstruction and secondary sepsis. During her stay, she experienced significant swelling following fluid resuscitation. Unfortunately, Ms. A died as a result of her illness, but prior to her death she wished to have her wedding ring removed to have the opportunity to give it to her daughter. Her wedding ring had not been removed from her finger for 36 years. The plan was to cut the ring if the CD was not successful.

The CD was able to remove her ring without complications. Ms. A was not distressed by the process. Following removal, her feedback was positive.


Case 2: Mr. B: A 62-year-old with hand trauma.

Mr. B is a 62-year-old male who injured his hand when it was caught in a garage door. His hand was significantly swollen when he arrived at the hospital. Mr. B reports being quite anxious about the prospect of having his ring cut off. Fifteen years earlier he had received a diagnosis of colon cancer, and prior to surgery he was informed that his wedding ring would have to be cut off. As an additional stressor to everything he and his family were experiencing, he reports the emotional impact of having his wedding ring cut was significant.

Following his hand injury Mr. B was wearing his university ring, another piece that is very important to him. When the opportunity to have the ring removed with the CD was offered he was happy to try. His ring was removed without complication. And although Mr. B was concerned that it may be painful due to his injury, he felt the device was able to relieve some of his discomfort during use. His ring was removed, and he was able to put it back on less than a week later.

Figure 3: Case 2 – CD applied to Finger

Case 3: Ms. C: 92-year-old female with a hand injury.

Ms. C is a 92-year-old who experienced a fall from standing in her home and suffered extensive bruising and swelling. Her left hand was left extensively bruised and swollen from fingers to elbow. A widow, she continued to wear her wedding band stating that she would have been ‘devastated’ should it have been cut off.

Ms. C was happy to have an option that would preserve her wedding band as she had promised to give the ring to her granddaughter. She was sceptical that it would work due to her extensive swelling. Ms. C reported mild discomfort when the CD device was placed over her knuckle, but no further pain during use. There were no other complications following successful removal of the ring.

Figure 4: Case 3 – Post Ring Removal

Case 4: Mr D: 34-year-old male with a fractured finger.

Mr. D is a 34-year-old male who collided with another player during a football match. He suffered a hyperextension injury to his 3rd and 4th digits of his left hand. They were initially bruised, and by the next day he was unable to move them. On his 4th finger was his grandfather’s “Claddagh ring” that was gifted to him when his grandfather died. Mr. D attempted ice and used cold water to reduce the swelling but was unable to remove his ring. He attended the emergency department and was told his ring finger was fractured. The CD was suggested as a way to avoid cutting the ring and he was happy to have the option as the ring had been custom-made in Ireland. The ring was easily removed with the CD, and he experienced only mild pain during the process.


Case 5: Ms. E: 60-year-old female with a persistently stuck ring.

Ms. E is a 60-year-old female who wore a ring with sentimental value that she had received from her husband during their honeymoon 30 years ago. The ring was tight when worn, and over the summer months her finger gradually became more swollen. During this period of time she attempted several methods to remove the ring including ice, soap and lubricants without success. Reading a news story about the CD, she reached out to the creator of the product and received an appointment to have the ring removed. At this point the ring had been stuck for six months. The ring was removed without any discomfort or complications.

Figure 5: Case 5 – Ring Removal Before & After

Case 6: Ms. F: 29-year-old female with a swollen finger.

Ms. F is a 29-year-old female who experienced swelling around a ring given to her on her 16th birthday. She wore this meaningful ring daily, removing it at night as a rule. One evening she was unable to take it off. Over the next few days her finger continued to swell. She attempted a variety of methods to try to remove the ring including cold water and using thread or a medical glove under the ring without success. She knew of the CD and contacted the creator for help. The ring was subsequently removed without complications.

Figure 6: Case 6 – Ring Removal Before & After

Final Comments from Participants

The following are comments provided by participants about their experience with the CD system after completing standardized questioning:

  • Case 1: “Positive experience overall 100%. Phenomenal experience to watch and see, I know how bad her hands were swollen, thought it (the ring) would have to be cut off for sure.”
  • Case 2: “No harm in trying. If somebody tried it and if they didn’t like it, they could stop. A great experience all way around, a relief and turned a bad day into a good day.”
  • Case 3: “Overall was wonderful that there was an option that worked.”
  • Case 4: “I said: ‘if it will save the ring, let’s try it’. We tried and it sure enough I hand my ring back whole. I can’t thank them enough for this. A family heirloom is saved because of this device.” 
  • Case 5: “Winner hands down, shouldn’t have a ring cut off when this is an option. This was easy, highly recommend it. Not sure why hospitals don’t have this as a standard of practice.”
  • Case 6: “A very cool device, should be something that people have if they want.”

Discussion

Failure to remove a ring following swelling, trauma, or a variety of other clinical and non-clinical situations can have significant consequences for both an individual and the ring itself. Although a variety of techniques have been developed over time to attempt ring removal, failure of any individual technique is common.1-10 The use of a ring cutter is often reserved as the definitive option for removal of persistently stuck rings. Damage to rings which often have significant sentimental value can be reduced if removed without cutting, and with increasingly common use of alternative metals used for rings, conventional ring cutters may not be a viable option for harder metals.11

With a wide range of jewellery types and metals available, emergency departments have depended on a variety of tools including wheel cutters, saws and various types of bolt cutters. These tools have their own drawbacks as they are often time consuming, require some proficiency, and can cause local trauma, typically minor however occasionally serious, during their use in addition to damaging the ring.11, 12

Because of these factors, a safe and easy option to use as an alternative for ring removal in the emergency department, or other setting, is of benefit. Based on this small case series, a CD may be one such option. This small case series reports success in a range of patient presentations including trauma, idiopathic swelling, post-resuscitation edema and constriction. The swelling encountered also varied from moderate to severe swelling. The CD proved easy to use with minimal discomfort though one case with a known fracture described significant pain.

No other side effects were reported, and each of the cases were followed-up six to eight months after ring removal. The reviews by the patient experience were unanimously positive. Participants were given the opportunity to provide criticism or express concerns, to an independent third party without a conflict of interest, around the use of the CD and none were identified.

Disclosures

The authors have no financial relationship, nor have received compensation such as honoraria, grants, memberships, stock ownership or other equity interest from any individual or company associated with a compression device. No individual from any CD company,or with a financial interest in CD development, was involved in interviewing participants, analysis or production of this paper.

The RingRescue™ Company invited the authors to complete this case series and provided a list of potential cases. As such, this is a small series including a convenience sample of successful cases of ring removal.

Conclusion

Based on these six cases, the CD appears to be a potential method for removing stuck rings that may otherwise have necessitated cutting the ring. The CD was used safely on this group, pain was not significantly increased, there were no anticipated consequences and none were observed. Further evaluation of the CD with a chronological case series is necessary. However, using simply physics, the CD successfully removed rings for all the patients in this case series.

References

1. Cresap CR. Removal of a hardened steel ring from an extremely swollen finger. The American Journal of Emergency Medicine. 1995;13(3):318-20.

2. Belliappa PP. A technique for removal of a tight ring. Journal of Hand Surgery. 1989;14(1):127-.

3. Inoue S, MD, Akazawa S, MD, Fukuda H, MD, Shimizu R, MD. Another Simple Method for Ring Removal. Anesthesiology: The Journal of the American Society of Anesthesiologists. 1995;83(5):1133-4.

4. Kates SL. A Novel Method of Ring Removal From the Aging Finger. Geriatric Orthopaedic Surgery & Rehabilitation. 2010;1(2):78-9.

5. McElfresh EC, Peterson-elijah RC. Removal of a tight ring by the rubber band technique. The Journal of Hand Surgery: British & European Volume. 1991;16(2):225-6.

6. Mullett STH. Ring removal from the oedematous finger: An alternative method. The Journal of Hand Surgery: British & European Volume. 1995;20(4):496.

7. Paterson P, Khanna A. A novel method of ring removal from a swollen finger. British Journal of Plastic Surgery. 2001;54(2):182.

8. Taylor SP, Boyd MJ. Unusually difficult ring removal from a finger solved using a dental instrument. Emergency Medicine Australasia. 2005;17(3):285-7.

9. Thilagarajah M. AN IMPROVED METHOD OF RING REMOVAL. The Journal of Hand Surgery: British & European Volume. 1999;24(1):118-9.

10. Venters WB. Ring removal from a swollen finger: a refined technique. Journal of surgical orthopaedic advances. 2006;15(3):181-3.

11. Kapickis M, Kutz JE. Titanium alloy ring crush injury. The American Journal of Emergency Medicine. 2007;25(9):1084.e3-.e5.

12. DeBoer S, Amundson T, Angel E. Managing Body Jewelry in Emergency Situations: Misconceptions, Patient Care, and Removal Techniques. Journal of Emergency Nursing. 2006;32(2):159.