title: A comparison of two techniques for tungsten carbide ring removal.
abstract: BACKGROUND
  Emergency physicians may have difficulty removing modern rings made of hard metals such as titanium and tungsten carbide. These metals are exceptionally difficult or impossible to remove using standard ring cutters. Numerous alternative techniques for removal have been described, including the "umbilical tape" or "string technique" and, in the case of tungsten carbide, breaking the ring using locking pliers.
  
  
  OBJECTIVE
  We sought to compare the speed and effectiveness of tungsten carbide ring removal using these two techniques.
  
  
  METHODS
  Ten tungsten carbide rings were placed upon the finger of a standard medical simulation mannequin. The rings chosen were one-half size smaller than the mannequin's finger. Edema distal to the ring was simulated using foam tape. A single novice operator performed 10 trials using each of the techniques after a 10-minute orientation session. The success or failure of the technique and the time for removal were recorded for each trial. The mean removal times for the trials were compared using a paired t test.
  
  
  RESULTS
  All trials were successful. The rings were removed substantially faster using the locking pliers method (mean 23.1 seconds [95% CI 15.4-30.8] vs. mean 135.4 seconds [95% CI 130.2-150.6]). However, the locking pliers technique destroyed all rings and caused sharp ring fragments to be thrown up to 37 in.
  
  
  CONCLUSIONS
  Both the umbilical tape or string technique and the locking pliers technique successfully removed tungsten carbide rings in our model. The locking pliers technique is significantly faster but destroys the ring and creates potentially harmful shrapnel.
authors.affiliation: Emergency Department, University of Texas Health Science Center at Houston - Medical School, Houston, TX 77030, USA.
authors.forename: Carolyn L
authors.initials: CL
authors.lastname: Gardiner
authors.forename: Krista
authors.initials: K
authors.lastname: Handyside
authors.forename: Justin
authors.initials: J
authors.lastname: Mazzillo
authors.forename: Mandy J
authors.initials: MJ
authors.lastname: Hill
authors.forename: Eric F
authors.initials: EF
authors.lastname: Reichman
authors.forename: Yashwant
authors.initials: Y
authors.lastname: Chathampally
authors.forename: Brent R
authors.initials: BR
authors.lastname: King
mesh_terms: D004635:Emergency Medicine / Q000295:instrumentation / Q000379:methods*; D004636:Emergency Service, Hospital; D005385:Fingers; D006801:Humans; D055498:Jewelry; D008348:Manikins; D017973:Tungsten Compounds
chemical_list: D017973:Tungsten Compounds; C002802:tungsten carbide