Removal of a ring trapped on a finger may require use of a manual ring cutter.
A ring cutter should be tried whenever there is excessive swelling, evidence of finger ischemia, or when other methods fail.
- Edema or anticipated edema when ring will not slide off finger
- Rings made of soft materials (eg, gold, silver, copper, plastic)
- Laceration of underlying tissue
- Nonsterile gloves
- Mild antiseptic cleanser (eg, 2% chlorhexidine)
- Manual ring cutter
- Hemostat or pliers
- Eye protection (eg, face mask, goggles)
- Sometimes a powered ring cutting saw or a bolt cutter
- First, thoroughly lubricate the patient’s finger with a water-soluble lubricant, then use a circular motion with traction to twist off the ring the from the finger. Should that fail, try the string method or use a manual ring cutter.
- For rings made of hard material (eg, steel, cobalt, titanium), use a powered ring-cutting saw if available. If unavailable, a bolt cutter should be adequate and is usually easier to obtain. Use eye protection for yourself and the patient if using a bolt cutter because the pieces may shatter and become airborne.
- Some rings made out of hard but brittle material (eg, ceramic, tungsten) can be broken into pieces by applying pressure with vice grips.
- The site of maximum diameter (and obstruction to removal) is the proximal interphalangeal (PIP) joint.
- Patient comfort with excellent exposure of ring on finger
Step-by-Step Description of Procedure
- First, clean the surrounding skin with a mild antiseptic cleanser such as chlorhexidine.
- Slide the manual ring cutter's small hook (guard) under the ring to position the saw-toothed wheel that cuts the metal.
- Position the saw-toothed wheel over the ring and cut through it, if necessary, a little bit at a time.
- Spread apart the cut ends of the ring with a large hemostat or another tool (eg, pliers) and remove it.
- Clean any finger lacerations gently with a clean cloth or gauze and soap and water or a mild antibacterial wound cleanser such as chlorhexidine. Suture or bandage with gauze if protection is needed.
- A jeweler can usually repair rings cut in one or more places.
Warnings and Common Errors
Be aware of signs of finger ischemia, which is usually caused by the ring and indicates an urgent need to remove the ring:
- Blue-gray or white color of the distal digit
- Very prolonged or absent capillary refill
- No distal pulse by pulse oximetry
- Severe pain
Tips and Tricks
- Remind the patient to remove all rings before finger edema develops and is extensive enough to cause pain or vascular compromise if there is ever risk of a finger injury.
- If the tension is too great to spread the ring, another cut 180° from the original cut site can be made. This second cut allows the ring to fall off in two pieces.
- For rings made of hard material, one person can pull on each side of the ring to open it; each can use a paper clip.
- Kalkan A, Kose O, Tas M, Meric G: Review of techniques for the removal of trapped rings on fingers with a proposed new algorithm. Am J Emerg Med 31(11):1605–1611, 2013. doi: 10.1016/j.ajem.2013.06.009
- Gardiner CL, Handyside K, Mazzillo J, et al: A comparison of two techniques for tungsten carbide ring removal. Am J Emerg Med 31(10):1516–9, 2013. doi: 10.1016/j.ajem.2013.07.027
- Asher CM, Fleet M, Bystrzonowski N: Ring removal: An illustrated summary of the literature. Eur J Emerg Med 27(4):268–273, 2020. doi: 10.1097/MEJ.0000000000000658