Osteoarthritis after cold injuries

Abstract

Frostbite is a thermal injury resulting in localised tissue damage due to inadequate circulation when the ambient temperature is below freezing. Osteoarthritis (OA) can develop after cold injuries. A 30-year old rock-climber presented with clinical and radiological signs of OA in his right middle and ring finger distal interphalangeal joints (DIPJ). He denied any hand trauma but had suffered frostbite to his fingers at the age of 19 during a trip in the Himalayas. Arthrodesis was performed in a functional position for his activities. The exact pathophysiology is unknown, but it is believed that both freezing and rapid rewarming are contributing factors. We postulate that osteoarthritis after frostbite in young adults is more likely to occur as the growth plate is nearing maturity. Initially, the ischaemic insult is partially remedied during reperfusion, but further cartilage damage may continue during the remodelling phase as the young adult continues to be active and the joints are subjected to constant load transmission. This may explain the variability in the timing of clinical presentation with osteoarthritis. Arthrodesis is indicated for symptomatic cases and facilitates continued interest in active sports. Hobbies should be considered in the history, including exposure to extreme weather conditions when young active patients present with OA.

Level of Evidence: Level V, diagnostic study.