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BMJ Case Rep. 2010; 2010: bcr11.2009.2465.
Published online May 6, 2010. doi:  10.1136/bcr.11.2009.2465
PMCID: PMC3047524
Reminder of important clinical lesson
Website malfunction: a case report highlighting the danger of using electrical insulating tape for buddy strapping
Brian Meldan Devitt,1 Joseph F Baker,2 Eilis Fitzgerald,3 and Conor McCarthy4
1Royal College of Surgeons in Ireland, Cappagh National Orthopaedic Hospital, Finglas, Dublin, Ireland
2Mater Misericordiae University Hospital, Orthopaedics, Dublin, Ireland
3Cork University Hospital, Plastic and Reconstructive Surgery, Wilton, Cork, Ireland
4Irish Rugby Football Union, Balsbride, Dublin, Ireland
Correspondence to Brian Meldan Devitt, bdevitt/at/hotmail.com
Abstract
A case of injury to the third web space of the right hand of a rugby player, as a result of buddy strapping with electrical insulating tape of the little and ring finger, is presented. A deep laceration of the web space and distal palmar fascia resulted, necessitating wound exploration and repair. This case highlights the danger of using electrical insulating tape as a means to buddy strap fingers.
This case is important because finger injuries in rugby are very common. In many circumstances, players will use whatever tape is available to buddy strap their fingers to prevent injury or for protection following injury. Electrical insulating tape is readily available in rugby changing rooms and is frequently used to carry out strapping. However, insulating tape is not a good taping material for fingers, as it has a sharp edge that can incise the skin of the hand or finger. This case highlights a potentially serious web space injury that occurred as a result of buddy strapping with insulating tape. It is important to promulgate this knowledge to healthcare providers so that similar cases can be avoided in the future.
A 28-year-old man, a right hand dominant rugby player, buddy strapped his ring and little finger with electrical insulating tape in preparation for a match. The player had a previous volar plate injury to the proximal interphalangeal joint of his right little finger that necessitated regular strapping. During the game, the player caught his index and middle finger of the same hand in the underhem of his opponent’s shorts while lunging for a tackle from behind. The force required to complete the tackle resulted in the index and middle finger being pulled radially with respect to the ring and little finger. The player sustained a deep laceration of the third web space with splaying of the ring and little finger ulnarly. He was removed from the field and was treated by the team doctor. On examination, there was a 3 cm laceration, extending dorsally 1 cm distal to the middle and ring metacarpophalangeal joint (figure 1A) and, proximally, just distal to the distal palmar crease (figure 1B). Of note, a free edge of insulating tape was found stuck in the wound at the exact location of the laceration on the web space (figure 2A,B). No sensory or circulatory loss was noted.
Figure 1
Figure 1
A. Web space laceration dorsally. B. Laceration of the palmar surface.
Figure 2
Figure 2
A. Palmar view of buddy strapping with free edge of insulating tape visible. B. Dorsal view of buddy strapping.
Treatment
The player was transferred to hospital and underwent wound exploration and primary repair of his hand under general anaesthetic the following day.
Outcome and follow-up
The player returned to play in 4 weeks, with instruction to buddy strap the ring and middle finger with the appropriate material for a 6-week period while playing.
Finger and hand injuries are very common in rugby.1 Buddy strapping for dislocations, subluxations, or interphalangeal joint sprains is the mainstay of treatment.2 Strapping and taping of body joints represent the second most common form of protective equipment used by rugby players, second only to mouthguard usage.3 These techniques can prevent injury and protect the athlete from reinjury when returning to sport. Taping of fingers, and in particular buddy strapping, is used to protect an unstable joint where the uninjured finger acts as a splint to protect an injured joint on an adjacent finger. However, finger taping is not without its problems, as illustrated by Rashid et al, who reported on a case of fingertip necrosis following buddy strapping.4
One of the main tenets of healthcare provision is ‘primum non nocere’ (first, do no harm), and it is vital that as healthcare professionals we use the correct equipment and, more importantly, advise athletes as to the correct equipment to use to protect themselves from injury. In most circumstances, players will use the tape most readily available for buddy strapping, which is commonly electric insulating tape used for sock and boot taping. Electrical insulating tape is made from polyvinyl chloride material that is coated with rubber pressure-sensitive adhesive. The tape is water resistant, very adhesive and cheap, which make it an ideal taping material for everyday use. However, the tape has a sharp edge and is capable of incising through skin, particularly when the skin is moist.
There are a number of more appropriate strapping materials available; they range from self-adhesive tape, to Tegaderm, to commercially available straps.5,6 However, the most common taping material used in practice is zinc oxide tape. It is usually white, although sometimes tan or brown, in colour, non-elastic and sticky. It derives its name from the adhesive glue found on the tape, which contains zinc oxide. It comes in a variety of widths and is easy to tear to the appropriate length required. Its non-elastic properties make it the ideal tape for limiting range of movement of joints or for splint application.
In this case report, the mechanism of injury and direction of pull of the fingers caused significant stress across the third web space and put the skin under considerable tension. We believe the injury was exacerbated by the creation of a lead point in the web space by the sharp edge of the electrical insulating tape, which allowed the skin to tear as a result of the forces applied. The edge of the electrical insulating tape was found stuck into the skin of the web space directly at the point of the laceration. Had another, more appropriate material been used, it is doubtful that the injury would have been so extensive if it had occurred at all.
Learning points
  • This case illustrates the potential for serious injury when using electrical insulating tape.
  • Appropriate taping material (eg, zinc oxide tape) should be available for buddy strapping.
  • All athletes and members of the coaching staff, including the medical staff, should be strongly advised against the use of electrical insulating tape for the taping of fingers.
Footnotes
Competing interests: None.
Patient consent: Patient/guardian consent was obtained for publication.
1. Shewring DJ, Matthewson MH. Injuries to the hand in rugby union football. J Hand Surg (Br) 1993; 18: 122–4. [PubMed]
2. Barton N. Sports injuries of the hand and wrist. Br J Sports Med 1997; 31: 191–6. [PMC free article] [PubMed]
3. Marshall SW, Waller AE, Loomis DP, et al. Use of protective equipment in a cohort of rugby players. Med Sci Sport Exerc 2001; 33: 2131–8. [PubMed]
4. Rashid A, Ahmed OA, Diver AJ, et al. Love thy neighbor – a case report of fingertip necrosis following neighbour strapping. Injury 2005; 36: 220–1. [PubMed]
5. Ridha H, Crerar-Gilbert A, Fleming A. The use of Tegaderm for finger buddy-strapping: a dressing with many advantages. Ann R Coll Surg Engl 2008; 90: 525. [PMC free article] [PubMed]
6. Jensen C, Rayan G. Buddy strapping of mismatched fingers: The offset buddy strap. J Hand Surg (Am) 1996; 21: 317–18. [PubMed]
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