Page 101 - Journal of Special Operations Medicine - Spring 2014

An Ongoing Series

Preventing Ring Associated Injuries:

Think Twice About Wearing That Ring

Matthew J. Levy, DO, MSc; Kevin Gerold, DO, JD, MA (Ed)

aw enforcement and military personnel, especially Advances in metalwork now permit the use of stronger
L those engaged in tactical operations, routinely per- and more valuable materials for creating rings, includ-
form tasks in ways that place them at risk for serious ing titanium, platinum and their alloys. It is now possible
hand and finger injuries. Ring avulsion is one type of to wear aerospace-grade materials as finger rings. These
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injury that is especially devastating, potentially career- materials have a practical advantage of being stronger,
altering and easily preventable. lighter and less prone to corrosion or tarnishing than gold
or silver. Titanium, a metal once limited to use by the
A ring avulsion occurs when a ring (often a wedding engineering and aerospace industries, is now used com-
band or team ring) becomes snagged on a projection monly in the fabrication of jewelry. Titanium is the ninth
during a fall and the weight of the operator strips the most abundant element, and unlike gold and silver, tita-
soft tissues from the wearer’s finger, resulting in a severe nium will not melt and requires specialized milling tech-
laceration or amputation. These injuries require surgery, niques to create jewelry from a solid piece of this metal.
months of rehabilitation and may result in amputation
or a permanent loss of sensation and fine motor control The added strength and durability of the newer space-
of the affected finger. aged metals presents new challenges to healthcare pro-
viders who may have to remove one of these rings from
Simple prevention strategies, through policy, practice an injured finger. Some jewelers have expressed concern
and engineering techniques, can eliminate these injuries. that titanium rings might be difficult to remove in an
This article will review the mechanism for ring avulsion emergency. They advise that rings fabricated from pure
injuries and provide several prevention techniques. titanium are removable using a standard ring cutter. How-
ever, those fabricated from aircraft-grade titanium, which
contain additional metals such as aluminum or vanadium
Background
to increase strength, cannot be removed using a standard
People have worn rings on their fingers for decorative, ring cutter. Removing these rings requires industrial grade
symbolic and social purposes for thousands of years. rotary tools with a diamond or similar hardened blade.
The first accounts of wearing rings date back to the The heat generated from these tools during the ring re-
Bronze Age. The use of signet rings to indicate official moval can cause third degree burns of the finger.
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business dates back to the Old Testament. Finger rings
also symbolize treaties and agreements, including mar-
riage. The materials used to fabricate rings have been Mechanism of Injury
dictated by the availability of workable materials and Among the numerous published articles describing inju-
society’s perceived value of the material used. Jewelers ries associated with wearing finger rings, ring avulsion
often fabricate rings using materials such as gold or sil- injury is generally considered the worst. The injury oc-
ver that is soft and easily transformed into attractive or curs when ring is caught and the person’s weight strips
symbolic artwork. the soft tissues from the finger. Injuries can range from

This article was originally published in Winter 2009 edition of The Tactical Edge, the professional journal of the National Tacti-
cal Officers Association (www.ntoa.org), and is reprinted with permission.

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