Skin burns following cryotherapy in misdiagnosed pediatric injuries

Superficial local cryotherapy is frequently and safely used for pain relief following musculoskeletal injury or disease. However, serious skin complications have been reported in adults following inappropriate application. Skin burns following superficial local cryotherapy have not been previously reported in children. The consequences of inappropriate use of various forms of cryotherapy in four children following sport injuries are presented. They were all primarily misdiagnosed with a soft tissue injury. The incorrect usage was due to the high severity of the local symptoms and signs. They were all referred with partial thickness skin burns. Diagnosis on referral indicated a bone injury in all of them. The value of the initial clinical examination is emphasized considering that fractures, including physeal injuries, are more common than ligamentous lesions, and the high incidence of the radiographically occult acute injuries in children. The use of superficial local cryotherapy following injuries in children should always follow the rules of proper usage and should be avoided in cases that the clinical examination cannot exclude a potential sprain or fracture to prevent further ligament, joint or bone damaging.