Emergency Removal of Tungsten Rings
by: Bryce Millar, M.D.
The importance of removing rings and other jewelry from an injured extremity is well known to emergency room providers and hand surgery specialists. Swelling after an injury can create a tourniquet effect and may rapidly threaten the blood supply to a finger. Unfortunately, early swelling often makes it difficult or impossible to remove snug rings. The unusual hardness of tungsten rings may require special removal procedures in an emergency situation.
There are a few techniques available that may make it possible to remove the ring without damaging or destroying it. Elevating the hand to decrease blood flow and soaking the finger in ice water may relieve enough swelling to permit ring removal. Also, applying soap or another water-soluble lubricant may help. Other techniques have been described in medical literature including the use of umbilical tape or string, or even anesthetic injection to facilitate removal attempts.
If these procedures do not work it may be necessary to destroy the ring in order to remove it. Emergency room physicians encounter this problem frequently and are accustomed to using either hand-powered or battery-powered ring cutters to remove jewelry. Tungsten, however, is even harder than the cutting blades of these devices and attempts to use them will not be successful.
Fortunately, a simple technique is available that will easily fracture the ring without injury to the finger. Most hospitals have vice-grip type pliers in their orthopedic surgery equipment sets. The pliers are opened wide enough to accommodate the ring. They are then closed over the ring, tightening the locking mechanism approximately one-quarter turn with each attempt until the ring breaks. The ring will generally break into two or three large pieces. These should be collected and returned to the patient. Using the vice-grip pliers with slow, sequential tightening allows the ring to be fractured in a controlled manner without risk of further injury to the patient.
Bryce Millar, M.D.
