Unilateral Osteoarthritis of the Distal Interphalangeal Joints Following Frostbite

Abstract

Bone changes after significant cold injury are not uncommon (3), but typical osteoarthritis is rare. Schumacher previously reported a case of unilateral osteoarthritis involving both the proximal interphalangeal and distal interphalangeal joints after frostbite (4). Case Report In the winter of 1942, this 44-year-old, right-handed, Caucasian female was bicycling near Chamonix, France, while the temperature was approximately −150° F. She was wearing gloves and riding with her right hand working the hand brake and steering while the left hand was immobile in her jacket pocket. After thirty minutes of exposure, she noted that the second through fifth fingers of her left hand were painful, numb, and white from the proximal interphalangeal joint distally. The active right hand felt normal. She stopped at the nearest farmhouse and put her left hand into a warm oven. Increasing pain caused her to withdraw the hand after five minutes, at which time the second through fifth fingers were blistered. Several hours later she was treated by a physician who debrided the blisters and painlessly removed the nails of the second through fifth fingers although no anesthesia was administered. Further treatment consisted of daily dressings and application of a yellow salve until the skin completely healed six months later. At that time the patient first noted asymptomatic enlargement of the distal interphalangeal joints of the second through fifth fingers which has persisted unchanged until the present time. Physical examination reveals fairly large Heberden's nodes involving the left second through fifth distal interphalangeal joints associated with slight limitation of flexion. The skin and nails appear normal, and no abnormalities of the thumb or proximal interphalangeal joints are evident. The right hand is entirely normal. A postero-anterior roentgenogram of the left hand (Fig. 1) shows narrowing of the second through fifth distal interphalangeal joints with small marginal spurs and slight sclerosis. A comparison view of the right hand is normal. Discussion Roentgenograms of the left hand show typical osteoarthritis limited to the distal interphalangeal joints of the second through fifth fingers. The etiology can be traced to the frostbite injury twenty-seven years ago. Enlargement of the involved distal interphalangeal joints which developed six months following frostbite has persisted essentially unchanged and represents the clinically observed, Heberden's nodes. Earlier films were not obtained, and the osteoarthritis was not documented until this year. It is probable, however, that significant changes were present six months following frostbite at which time joint enlargement was first noted. Punched-out juxta-articular defects in bone have been reported as early as five months after cold injury (1).