Prevention of ring finger avulsion ("degloving"
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Transcript of Prevention of ring finger avulsion ("degloving"
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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
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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 %
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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
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Mechanism of the accident
The ring is caught...
… and forces the soft tissues to tearAmputation is frequent
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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
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Functional disability
Cosmetic impairment
Financial compensation
Consequences for the patient and the community
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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
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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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« 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
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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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Weak point (Bianchi et al 1969, Varela 1996)
unacceptable because visible and no biomechnical experimentation
Existing prevention devices ?
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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
Laboratoire d’anatomie de la
Faculté de Médecine des Saints Pères
Thresholds of finger resistance/Adlife rings
Ecole Nationale d’ Arts & Métiers
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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
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Reliability of Adlife device
Low speed High speed
Opening threshold
350 N < 5 Kg
Severe lesions 0 0
Adlife140 tests
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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 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