Radiographic changes in the hands following childhood frostbite injury

Three young adult patients who had sustained severe frostbite of the hands as children were recently evaluated for progressive deformity and joint pain in the fingers. Characteristic radiographic abnormalities including dwarfing of the middle and distal phalanges, irregular and malapposed articular surfaces, malalignments at the proximal and distal interphalangeal joints, and evidence of degenerative arthritis in the interphalangeal joints were observed. The metacarpal phalangeal joints and wrists were spared in all patients, and fingers which had been protected from the initial cold injury were similarly not affected. Articular abnormalities and phalangeal deformity are most likely due to direct chondrocyte injury following freezing, but microvascular damage may also contribute to abnormal cartilage growth. A history of severe frostbite as a child should alert the clinician to the possibility of finger deformity and arthritis developing years after the initial injury.