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This report describes 2 new cases of toe tourniquet syndrome without accompanying signs of irritability. They were an 18-month-old girl and a 5-month-old boy suffering from strangulation of the third toe. The period of evolution was 20 days and 5 weeks. The toe worsened, with more extensive reddening and swelling, and deepening of the circular groove. Since a hair tourniquet was suspected, attempts were made to grasp the fiber with small-sized, blunt, and hook-shaped instruments, and mosquito clamp, with no success. The strand of hair compressing the toe lay deeper than expected. As improvement was barely noticeable, 2 dorsal paratendinous incisions were made and the hairs were extracted. Our aim is to raise awareness in the pediatric orthopaedic community of the existence of this syndrome, with a view to promoting the earliest possible diagnosis and appropriate management. In case of impossibility of removing the hairs we propose performing 2 dorsal paratendinous incisions, deep to the bone, to release completely the strangulation.
Hair thread tourniquet syndrome is rare and usually affects little children. If the tourniquet is not incised, the affected body part becomes ischemic or even necrotic. An 18 mo old girl was seen in the emergency ward with a painful, red and swollen third toe of the left foot. The toe appeared to be strangulated with a hair, and the diagnosis hair thread tourniquet syndrome was made. After incision of the hair tourniquet the symptoms soon subsided. The diagnosis is easily made if the clinical features are recognized. However, if the tourniquet is not cut through, the affected body part may become ischemic and even necrotic.