A Case Study of the Ring Rescue Dolphin™ Ring Cutter
Ring Rescue Dolphin™ Ring Cutter Successfully Cuts Both Sides of Titanium Wedding Ring In 10 Minutes
Case Study Written by Jennifer Emeshih and Louis Staple, Originally Published by JEMS 9.14.2023
In recent years, jewelers have noted the growing popularity of titanium wedding bands as they are relatively inexpensive, lightweight, hypoallergenic and durable.1 These sentiments, however, are not always shared by the Emergency Department (ED) staff assigned the often time-sensitive task of removing a ring from a swollen finger.7 A ‘stuck ring’ is a relatively common ED presentation, and several non-cutting techniques can often be employed to remove stuck rings.1
Ring cutting is usually a last resort for ring removal as it not only causes damage to a ring, but the cutting device is often unavailable, or not specifically designed for use on patients.2 Rings made of harder metals such as tungsten, steel, and titanium, however, have historically required specialist cutting tools with dental saws, electric saws, rotary tools, diamond-tipped saws, or dental drills.1 These techniques can lead to thermal or mechanical injury of the finger, are time intensive and often require several medical personnel.3
In this report we describe a case of ring removal using the Dolphin Ring Cutter™: an innovative device that is attempting to provide a safe and fast method to cut stuck rings even when constructed from hard metals. This ring cutter is a handheld automated device that uses specially designed discs to cut a ring in half by cutting at two separate angles 1200 to 1800 apart.4 The patient’s hand is placed on a flat surface, and the finger guard of the cutter is placed under the ring protecting the finger on one side, while also automatically guiding the cutting disk on the other side. A lubricant is sprayed on the ring and finger to reduce heat generation, and the cutter automatically progresses through the ring while providing indicators of progress and warnings such as when additional lubricant is required.
Case Presentation
Mr. Y is a 52-year-old male who presented to the ED with a stuck titanium ring approximately 24 hours after the back of his left hand was injured by a volleyball. He noticed slight swelling at the time of the injury. He briefly applied an ice pack to the left hand and was able to complete his game. Mr. Y noticed worsening swelling and pain the following day and alternated between cooling and heat to reduce swelling but was unable to remove his ring. At the time of presentation to the ED, his finger was significantly swollen with a dusky red discoloration of the entire digit distal to the ring (Fig 2a).
The patient expressed the desire to preserve the ring as it was his wedding band which had significant sentimental value to him. A compression device was first used to attempt ring removal. Unfortunately, these efforts were unsuccessful (Fig 2b). After two unsuccessful attempts, the Dolphin ring cutter was suggested, and although he was disappointed with the idea of cutting his ring, understood the need for removal and consented to having the band cut. The titanium ring was cut within minutes by the Dolphin cutter; he experienced no pain or discomfort during the process. Mr. Y had no side effects from the procedure and reported the swelling of his finger was completely resolved by the next day.
When asked about his experience, Mr.Y indicated: “I had an excellent experience, it was a pretty straight forward procedure and went smoothly.”
Discussion
Several authors have described various ring cutting methods that often require two or more healthcare workers with sufficient training on safe use of cutting tools and injury prevention techniques [1-8]. Cutting a stuck ring in the ED can have significant consequences, both the potential for injury during removal as well as the psychological stress from losing the ring. Devices that allow for safe and efficient removal of rings is a necessity, especially in busy EDs. The Dolphin Ring Cutter acted as one such devices in this case.
The procedure was performed by an ED paramedic who notes the ring cutter was “a great tool and easy to use.” It took only “approximately 10 minutes to cut through both sides.” They felt well prepared to utilize the tool and had access to additional instructional videos for guidance in the event they encountered difficulty. Overall, both patient and paramedic felt the process went smoothly and quickly. The first attempt to remove the ring was done using a compression device. Unfortunately, a nodule at the joint of the ring finger (Fig 4) prevented the compression method from working, and as such a switch to a cutting technique was performed.
Conclusion
There are several known techniques for removal of a stuck ring in the ED. Health care professionals should adhere to ring removal algorithms for complex cases, taking into careful consideration the sentimental value of the ring as well as the patient’s safety, wishes and concerns at the time of removal. Advancement in technology such as the device used in this case has made ring cutting devices more accessible for ED staff. The Dolphin Ring Cutter used in this case does not require extensive training, and may be a safe and effective option for removal of rings in the ED.
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References
1. A. Kalkan, O. Kose, M. Tas and G. Meric, “Review of Technique for the removal of trapped rings on fingers with a proposed new algorithm,” American Journal of Emergency Meidicne, pp. 1605-1611, 2013.
2. M. Thilagarajah, “An Improved Method of Ring Removal,” Journal of Hand Surgery (British and European volume), pp. 118-119, 1999.
3. S. Taylor and M. Boyd, “Unusually difficult ring removal from a finger solved using a dental instrument,” Emergency Medicine Australasia, pp. 285-287, 2005.
4. RingRescue, “The Dolphin Ring Cutter,” 27 February 2023. [Online]. Available: https://www.ringrescue.com/.
5. A. Salibi and A. Morritt, “Removing a Titanium Wedding Ring,” Emerg Med J, pp. 170-171, 2016.
6. S. Kates, “A Novel Method of Ring Removal From the Aging Finger,” Geriatric Orthopedic Surgery & Rehabilitation, pp. 78-79, 2013.
7. C. Cresap, “Removal of Hardened Steel Ring from Extremely Swollen Finger,” American Journal of Emergency Medicine, pp. 318-320, 1995.
8. L. Staple and C. LeBlanc, “A Novel Approach to Ring Removal: Compression Device,” Halifax, 2020.
