An unusual form of 'finger stuck in a hole' injury in a child.

Sir,

Children have an unique ability to convert the most safe looking toys or objects into complex medical challenges. Their juvenile experiments and consequent ‘stuck fingers’ with rings, keyholes, electric sockets, padlocks, or any orifice that can be thought off is well known as is the story of the brave boy Hans Brinker who saved the city by putting his finger in a hole in a dyke that would have otherwise flooded the Haarlem city in Holland.[1]

A 3-year-old child was referred with a history of the index finger being stuck in a plate hole. ‘Idli’ or simply steamed rice cake, made by steaming a batter consisting of fermented black lentils (de-husked) and rice is a south Indian delicacy that is prepared in moulds where the batter is put in and steamed. The steam enters through small holes in the mould and cooks the batter. With the advent of pressure cookers, the ubiquitous idli can be prepared in steel moulds that are placed inside a pressure cooker. Our toddler had managed to ingeniously slide his finger into the central hole in the steel mould while playing with it and turning it round and round over her finger [Figure 1a]. Eventually the distal finger became edematous and it was then that the parents realized that the idly mould had become a inseparable part of their toddler's finger. All attempts at home to pull out the ‘stuck finger’ failed and the child was taken to a local hospital where the standard modes of removal were attempted. The child was then brought to our center. The unusual shape of the mould made us realise that cutting the plate away was the only way to remove the finger. The child was fairly co-operative and hence it was decided to try removing the ‘stuck finger’ under local anesthesia. Additional analgesic support and sedation was given in the form of oral syrup paracetamol and syrup triclofos. One percent solution of Lidocaine was injected as a ring block to anesthetize the index finger. An attempt was made to cut the plate with a regular wire cutter which failed. A heavy duty steel plate cutter was then procured and the steel mould was then cut into two parts across the circumference and the finger removed [Figure 1b]. Besides a small laceration on the finger that was left for secondary healing, no other injuries were noted.

Figure 1

(a) Photograph showing a child's finger stuck in a idli mould hole. (b) Photograph showing the finger after removal with a small laceration

Finger injuries are quite common in childhood and one study reported an incidence of 38% in those below 5 years.[2] ‘Finger stuck in a hole’ is a common casualty presentation and various different techniques have been used for its removal. A number of household items such as soap solution, shampoos, Vaseline, butter, cooking oil, and baby oil have all been used as lubricants to manipulate and gently remove the finger stuck in a hole. If the skin is abraded then an antibiotic ointment is preferred as a lubricant. Exposing the finger to cold water for a few minutes causes vasoconstriction and the consequent reduction in finger circumference may help to remove the stuck finger. Using a thread or string is a well known technique in which the string is passed under the ring and then wound distally around the finger snugly but not too tightly so as to avoid distal ischaemia. The thread is then unwound just distal to the ring or hole and as the string is unwound the ring slides off the finger. This process is repeated if needed till the finger is completely released from the ring or hole. Most often these techniques succeed but at times even a high speed dentist's drill has been used to remove the ‘stuck finger’.[3] In our case, a heavy duty plate cutter was used. This letter is written only to highlight the unusual form of injury and to drive home the fact that children can turn any object or toy in their hands to a medical emergency such as the ‘Idli’ mould in our case.