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Ring Avulsion Injuries: A Systematic Review.

Ravinder Bamba1,2, Gautam Malhotra3, Reuben A Bueno1

  • 11 Vanderbilt University, Nashville, TN, USA.

Hand (New York, N.Y.)
|July 20, 2017
PubMed
Summary
This summary is machine-generated.

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Ring avulsion injuries vary in severity. This review found that while high-grade injuries (class III) traditionally led to amputation, some can be successfully salvaged with microsurgical revascularization, improving patient outcomes.

Area of Science:

  • Orthopedic Surgery
  • Microsurgery
  • Trauma Care

Background:

  • Ring avulsion injuries present a spectrum from soft tissue damage to complete amputation.
  • Current grading systems exist, but controversy surrounds the management of high-grade injuries.
  • Historically, severe ring injuries often resulted in amputation, though salvage is increasingly possible.

Purpose of the Study:

  • To systematically review and synthesize published data on the treatment and outcomes of ring avulsion injuries.
  • To evaluate the effectiveness of current management strategies for different severities of ring avulsion.

Main Methods:

  • A systematic literature review was performed using PubMed and MEDLINE databases.
  • English-language studies published between 1980 and 2015 were included.
Keywords:
avulsion injurycompletion amputationmicrosurgeryreplantationring avulsion

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  • Data from 20 studies involving 572 patients with ring avulsion injuries were analyzed.

    • Main Results:

    • The Urbaniak classification system was used: Class I (54 patients), Class II (204 patients), and Class III (314 patients).
    • Average Total Arc of Motion (TAM) and 2-point discrimination varied by injury class and treatment.
    • Class I: TAM 201.25, 2-point discrimination 5.6. Class II (revascularized): TAM 187.0, 2-point discrimination 8.3. Class III (revascularized): TAM 168.2, 2-point discrimination 10.5.

    Conclusions:

    • Ring avulsion injuries are typically graded using the Urbaniak system.
    • Outcomes are generally better for Class I and II injuries.
    • Selected Class III injuries may be amenable to replantation, emphasizing shared decision-making with patients.