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Digital avulsion
Definition
Digital avulsion is a very serious condition that occurs more frequently than people generally believe.
We differentiate between two types:
Number one is the degloving of the finger (fig 1):
The whole skin and the underlying tissue are separated from the bone. On one side of the hand is the bare bone and on the other side the soft parts like a cut glove finger (therefore it is called degloving).
The whole vascular nervous system is affected.
Number two is the complete amputation of one or several phalanx (fig 2).
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Fig.1 : Degloving (picture Thierry Dubert) |
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Fig 2: Complete amputation |
Mechanism of the lesion
A thin ring (such as a wedding ring) that gets stuck in a hold while the feet are sliding, can cut through all the flesh and thus separate the skin from the bone like a thread cuts through butter.
In the same way, the finger can be severed completely by the ring (fig 3).
Fig.3 : Mechanism of avulsion by a ring
A finger that is introduced in an expansion piton, can be subjected to the same fate.
Other mechanisms while falling: the leader sometimes tends to hold on to the rope tightly at the knot. If the rope is spiralled, one or more fingers can be severed (not as clean a cut as by a ring) the moment the rope is tightened.
It can also become dangerous for the belayer’s fingers during a high fall, because the rope can slide in the brake and get the fingers caught in the device.
All these examples of accidents have really happened.
Prevention
Technique correction:
Never climb with a ring.
Never put your finger in an expansion piton, a piton or a sealing.
Learn to fly, and train regularly to do it so as to lose the reflex of catching the rope in front of you.
Treatment
In cases of complete amputation or degloving:
Gather together the fragments,
Put them in a closed plastic bag,
Put the bag in ice.
On the traumatized hand: do not use a garrot,
Make a compressive dressing and keep the hand raised as much as you can.
Call the nearest hand surgery centre immediately.
To know the nearest centre in France, call the following number:
0 825 00 22 21
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