Findings: These are two views of the left hand demonstrating a patchy periarticular osteoporosis as well as findings suggestive of acroosteolysis. In addition, there is ankylosis of the second through fourth proximal interphalangeal joint as well as apparent contractures. The first interphalangeal joint is relatively uninvolved. The metacarpophalangeal joint, carpometacarpal joints, and carpus are entirely uninvolved.

Diagnosis: Frost-bite.

Discussion: The development in progression of frost-bite injuries are directly related to abnormalities in circulation as well as the direct results from cellular injury and necrosis secondary to the freezing process itself. The findings are most marked in the hands and feet with severity depending on nature and length of exposure. Initially, there may be no radiographic abnormality but soft tissue swelling and loss of soft tissue, especially at the distal digit soon becomes apparent. In the hand, the findings associated with frost-bite predominate in the second through fifth digit with relative sparing of the first. This is presumably secondary to the patient clenching their fist with thumb clasped in the palm. The skeletal manifestations are variable, primarily involving the proximal and distal interphalangeal joints as well as the distal tufts of the digits. There may be fragmentation, and destruction. In addition, there are often interphalangeal abnormalities including severe joint space narrowing, sclerosis, osteophytosis, and soft tissue swelling. There may be erosions similar to those seen in erosive osteoarthritis. In severe cases, the joint space narrowing may progress to bony ankylosis. The differential diagnosis for acroosteolysis would include frost-bite, collagen vascular disease, neuroarthropathy, hyperparathyroidism, and psoriatic arthritis, electrical and thermal injury, and progeria. Associated diagnostic findings will help differentiate these entities from frostbite.

Reference:
Resnick D. Diagnosis of Bone and Joint Disorders, 2nd Edition.
W. B. Saunders, Philadelphia. 1988;3009-3014.

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