An Unusual Foreign Object Attached to a Child's Finger: Emergency Department Management and Subsequent Intervention

Strangulation injuries due to foreign objects are uncommon presentations of hand and finger injuries presenting to the emergency department (ED). Ring avulsion and hair tourniquet injuries are more commonly recognized mechanisms of strangulation, and algorithms for subsequent management and emergent treatment exist for these injuries. It is important to distinguish between hand injuries that can be managed in the setting of the ED and those that need emergent surgical management upon patient presentation. Nonemergent presentations of finger injuries include metallic bands or other objects trapped on digits without signs of neurovascular compromise. A 2-year-old girl presented to our ED with her right index finger trapped within a stainless steel salt shaker (2.55 in. H × 3.5 in. W × 4.9 in. D). The distal aspect of the digit was unable to be visualized, and communication with the patient was difficult secondary to distress and young age. Multiple attempts were made to remove the object in the ED by multiple health care providers, when concern for degloving injury prompted the patient to be taken to the operating room for removal with an electric saw by the hand surgeon and orthopedic team.