Impact of Thrombolytic Treatment on Functional Rehabilitation in Severe Frostbite Patients

Thrombolytics improve limb and digit salvage following severe frostbite injury; however, disability following thrombolytic therapy is largely undescribed. Our aim was to evaluate functional status, pain, and disability in a large cohort of patients with severe frostbite treated with and without thrombolytics, hypothesizing no significant differences between the 2 groups. Longitudinal cohort study of patients with severe frostbite injures over the winters of 2013-2020. Therapy and clinic notes were reviewed at discharge and follow-up. Outcomes-including requirement for assistance or modifications for activities of daily living (ADLs), grip strength, ambulation status (independent, assisted, or non-ambulatory), and the presence of pain, edema, numbness, throbbing, or hyperesthesia-were categorized. The cohort included 182 patients, 75.8% received thrombolytics. Over a third of patients required assistance with ADLs (32.6% no thrombolytics vs 46.7% thrombolytics, P = .115). Return to pre-injury work status was equal between the 2 treatment groups. Reports of neurologic pain, edema, and numbness were all higher in the thrombolytic-treated group, while throbbing was higher in the non-thrombolytics group, but none reached statistical significance. Significantly more non-thrombolytic-treated patients required amputation. Of those with at least 1 clinic follow-up (n = 133), 98 were treated with thrombolytics. Higher proportions of thrombolytics patients were independently ambulating at follow-up. No significant differences in reported pain, edema, swelling, hyperesthesia, or throbbing between the treatment groups were observed at follow-up. When examining those treated with or without thrombolytics that did not require amputation, the results mirrored the cohort. When assessing outcomes based on extremity impacted by frostbite, only independent ambulation was significantly higher in patients with lower-extremity injuries treated with thrombolytics. This is the first long-term evaluation of functional outcomes of thrombolytic-treated patients with severe frostbite. Future research is needed to incorporate the systematic documentation of functional outcomes using validated performance and patient-reported outcomes measures. Thrombolytic therapy is a valuable intervention in preventing amputation following severe frostbite injury and functional recovery of salvaged limbs and digits warrants additional study.