A wedge technique for digital entrapment: a case report of releasing a finger stuck in a wooden hole
Article information
Abstract
A finger-in-hole entrapment requires prompt, safe release to prevent vascular congestion or edema, which leads to poor perfusion or limb compression. Herein, we describe a novel, safe, and painless wedge technique for release of the entrapped finger from a wooden hole, using a flathead screwdriver and without the use of procedural sedation and analgesia. This case report will prepare emergency physicians or pediatricians who provide care for patients presenting with this type of entrapment, thereby avoiding the complications of invasive or less comfortable releasing techniques.
Introduction
Toymakers can dry wood materials, create small holes, and sand the wood to create a smooth, inviting finish. Small, curious children often play with such wooden toys and may have their fingers accidentally entrapped in the holes. Typically, emergency physicians or pediatricians might attempt the standard ring-removal techniques, using lubricants, traction, compression, or cutting (1). However, children often refuse to cooperate with the techniques, leading to patient anxiety, discomfort, or risks of worsening edema or cutting the finger. Although some anxiety or discomfort could be reduced by procedural sedation and analgesia (PSA), it has its own risks such as adverse effects of medications. A 1-2 cm or less thickness of a wooden toy, which may entrap the finger, is vulnerable to wedge splitting by a sharp, forceful tool working at a distance to release the entrapped finger. This wedge technique may release the finger safely and painlessly, even without using PSA. Herein, we report the application of the wedge technique on a 4-year-old boy whose little finger was entrapped in a hole in a wooden toy. Written informed consent for publication of his clinical details was obtained from the parent during a follow-up appointment.
Case
A 4-year-old boy with an autism spectrum disorder stuck his right little finger into a small notched hole of a wooden train track during a routine behavioral therapy session at an outpatient clinic when out of the sight of supervising adults (Figure). The finger was entrapped between the metacarpal phalangeal and proximal interphalangeal joints. Right after the entrapment, his therapist tried to release the finger with lubrication, cooling, and traction, and then requested an assessment from the authors who were working in an adjacent clinic at that time. Upon our initial assessment 15 minutes after the entrapment, the finger was minimally swollen from the failed attempts. There was no severe soft tissue injury, bleeding, abrasion, laceration, or compromised circulation.
The wedge technique for releasing the entrapped finger. The boy’s right little finger is entrapped in the hole of a wooden train track (see the toy before the entrapment in the inset). The handle of a flathead screwdriver was tapped into the track with the blade edge aligned along the wood grain coursing towards the hole.
After another 10 minutes of assembling the appropriate tools, we rested the track over the edge of a table while the boy’s mother held him. With a small hammer, we tapped the handle of a flathead screwdriver, whose blade was less than 1 mm thick, into the toy at the end opposite the hole (see the inset in Figure). We counted the number of taps aloud, thereby engaging the boy’s calm interest and cooperation. Since we successfully performed the painless technique and distracted him, he remained comfortable and calm, forgoing PSA. After a couple of dozen taps, the wedge of the screwdriver blade slowly split the end of the toy, which enabled us to manually pull it apart into 2 halves, extending the split to the hole and releasing the finger. After the release of the entrapped finger, he completed his therapy session and went home. During the entire procedure, immediately after the release, and for several weeks, he showed no signs of pain or injury.
Discussion
This case presents the application of a unique and relatively simple approach for resolving a situation where a child’s finger was caught in a wooden hole, using basic household tools such as a hammer and screwdriver. In a similar but unreported case, the first author hammered a small chisel as a wedge to split a slat of wood at a safe distance from a finger entrapped between the metacarpal phalangeal and proximal interphalangeal joints, and then extended the split towards the hole by pulling apart the wood, thereby painlessly releasing the finger. It carries less risk to use the technique of wedge splitting the wood at a safe distance from the finger with a sharp and forceful tool, than to cut directly into the hole, which would bring a sharp tool next to the finger, or to bluntly and forcefully break the wood, which could crush the finger between splintered wood fragments.
The fortuitous arrangement of cells in a tree provides both strength and flexibility and leads to the distinct biologic anisotropy of wood, which is 8-10 times stronger across the grain than along it (2). This anisotropic strength explains why splitting a log along the grain is easier than sawing it across the grain. Likewise, this relative weakness along the grain permitted us to split the wood safely at a distance from the patient’s finger, to extend the split carefully towards the entrapment, and to release the finger without immediate proximity to sharp or forceful tools.
Our case report describes a novel technique that does not require PSA or referral to an emergency department. This suggests that prompt, judicious, and calm management in a low-resource setting can mitigate the need for escalation of care or invasive interventions. Likewise, Choi and Hwang (3) reported a novel noninvasive technique for zipper removal from an entrapped eyelid, using lidocaine gel for both topical anesthesia and lubrication. Their case report provides a documented method to release specific types of entrapment without employing a rare tool, invasive technique, or PSA. By choosing such a noninvasive technique, emergency physicians or pediatricians can save time, resources, or invasive procedures.
This novel technique for releasing the finger stuck in a wooden hole utilizes common household tools, such as a hammer and screwdriver, and provides an accessible, cost-effective solution for a perplexing and stressful situation. By relying on familiar everyday tools and the knowledge of wood’s anisotropic strength, this method can save resources, circumvent escalation of care, and avoid the patient risk, discomfort or anxiety of more invasive techniques.
Notes
Author contributions
Conceptualization: all authors
Supervision and Validation: PSK
Writing-original draft: all authors
Writing-review and editing: all authors
All authors read and approved the final manuscript.
Conflicts of interest
No potential conflicts of interest relevant to this article were reported.
Funding sources
No funding source relevant to this article was reported.