Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jan;13(1):15-22.
doi: 10.1177/1558944717692094. Epub 2017 Feb 16.

Ring Avulsion Injuries: A Systematic Review

Ravinder Bamba  1   2 , Gautam Malhotra  3 , Reuben A Bueno Jr  1 , Wesley P Thayer  1 , R Bruce Shack  1
Affiliations

Ring Avulsion Injuries: A Systematic Review

Ravinder Bamba et al. Hand (N Y). 2018 Jan.

Abstract

Background: Ring avulsion injuries can range from soft tissue injury to complete amputation. Grading systems have been developed to guide treatment, but there is controversy with high-grade injuries. Traditionally, advanced ring injuries have been treated with completion amputation, but there is evidence that severe ring injuries can be salvaged. The purpose of this systematic review was to pool the current published data on ring injuries.

Methods: A systematic review of the English literature published from 1980 to 2015 in PubMed and MEDLINE databases was conducted to identify patients who underwent treatment for ring avulsion injuries.

Results: Twenty studies of ring avulsion injuries met the inclusion criteria. There were a total of 572 patients reported with ring avulsion injuries. The Urbaniak class breakdown was class I (54 patients), class II (204 patients), and class III (314 patients). The average total arc of motion (TAM) for patients with a class I injury was 201.25 (n = 40). The average 2-point discrimination was 5.6 (n = 10). The average TAM for patients with a class II injury undergoing microsurgical revascularization was 187.0 (n = 114), and the average 2-point discrimination was 8.3 (n = 40). The average TAM for patients with a class III injury undergoing microsurgical revascularization was 168.2 (n = 170), and the average 2-point discrimination was 10.5 (n = 97).

Conclusions: Ring avulsion injuries are commonly classified with the Urbaniak class system. Outcomes are superior for class I and II injuries, and there are select class III injuries that can be treated with replantation. Shared decision making with patients is imperative to determine whether replantation is appropriate.

Keywords: avulsion injury; completion amputation; microsurgery; replantation; ring avulsion.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flowchart of MEDLINE search, including number of citations identified at each part of search.
See this image and copyright information in PMC

References

    1. Adani R, Castagnetti C, Busa R, et al. Ring avulsion injuries: microsurgical management. J Reconstr Microsurg. 1996;12(3):189-194. - PubMed
    1. Adani R, Castagnetti C, Busa R, et al. Transfer of vessels in the management of thumb and ring avulsion injuries. Ann Acad Med Singapore. 1995;24(4 suppl):51-57. - PubMed
    1. Adani R, Marcoccio I, Castagnetti C, et al. Long-term results of replantation for complete ring avulsion amputations. Ann Plast Surg. 2003;51(6):564-568; discussion 569. - PubMed
    1. Adani R, Pataia E, Tarallo L, et al. Results of replantation of 33 ring avulsion amputations. J Hand Surg Am. 2013;38(5):947-956. - PubMed
    1. Akyurek M, Safak T, Kecik A. Ring avulsion replantation by extended debridement of the avulsed digital artery and interposition with long venous grafts. Ann Plast Surg. 2002;48(6):574-581. - PubMed

Publication types

LinkOut - more resources