Ring removal from a finger or toe

* Refer to UpToDate topics on treatment of digital fractures or lacerations.

¶ If an electric ring cutter is available, the device and blade (eg, diamond or carbide) will say which metals it can cut (and which blade to use if ring composition is unknown). This may be preferable to breaking a tungsten or ceramic ring if the device can cut these metals. Follow the manufacturer's instructions on lubricating or cooling the electric ring cutter.

Δ Make cuts 120 to 180 degrees apart on the palmar and volar surface of the ring. Dentists, fire fighters, machinists, or other aid personnel may have greater proficiency with the safe use of devices not originally designed for medical applications. Essential safety measures also include:

• Provide industrial eye protection for the patient, provider, and all other people present during the procedure.
• Cover the patient's exposed skin with wet gauze to protect it from sparks and metal filings.
• Insert a metal barrier (eg, metal laryngoscope blade, flat surgical instrument, or the guard on the electric ring cutter) between the ring and the digit.
• Cool the ring and drill or saw with ice prior to the procedure and constantly drip cold water over the cutting site during the procedure with frequent breaks to assess for overheating of the ring.

◊ If there is a possibility that the ring is steel or titanium, do not attempt breaking it since that may crush the ring onto the finger. Firemen, machinists, or other aid personnel may have greater proficiency with the safe use of locking pliers. The patient and provider should both wear eye protection. Set the pliers to one turn smaller than the ring circumference. Apply them circumferentially around the tungsten or ceramic ring and close them steadily with control until the ring breaks open. Alternatively, apply the ring vise per manufacturer's instructions and turn the knob until the ring breaks.