Objective Hair-thread tourniquet syndrome is an unusual condition and is often confused with non-accidental injury (NAI). We report 2 cases of hair-thread tourniquet syndrome presenting as NAI followed by a brief review of literature.

Methods Case reports and literature review.

Results Two children were referred with suspicion of non-accidental injury with circumferential wounds affecting the digits. The first child, an 11 week old boy, had a cut encircling the right third toe at the level of the distal interphalangeal joint. Swelling and erythema were present distal to the lesion. On further assessment the inside of the child’s socks was noticed to have loose threads. Grandmother reported pulling out a thread from the lesion sometime earlier. The other child, a 2 month old girl, presented with a similar lesion on the right thumb. She was noticed to be playing with mum’s hair frequently. Examination under an operating microscope revealed a hair within the lesion, which was removed. Both children recovered uneventfully.

Conclusions Hair-thread tourniquet syndrome is a rare condition affecting the appendages, mostly in infants and young children. This can involve fingers, toes and sometimes genitals, when they are accidentally strangulated by a hair or thread. This leads to obstruction of the circulation resulting in swelling, ischaemia and eventually necrosis. Early diagnosis and treatment is essential to prevent permanent damage. Awareness of this interesting condition, coupled with a thorough history, will prevent misdiagnosis as non-accidental injury.