Assessing And Treating Cold-Related Injuries Among Athletes

Start Page: 111
Here we see frostbite on both feet of a 49-year -old patient.  Note the marked purple, cyanotic appearing discoloring of the digits.
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Author(s): 
By Mark Caselli, DPM

What About Post-Thaw Therapy?
Management of frostbite injuries after thawing should be of a protective nature. Protect the skin with soft, sterile bandages and emphasize judicious use of topical or systemic antibiotics. Blisters should be left intact when possible, but be aware that debridement may be required after the patient has arrived at your facility. The inflammatory cascade can be inhibited by ibuprofen and aloe vera cream. You should administer tetanus toxoid to all frostbite patients.
Emphasize to patients that they should protect the involved skin from prolonged contact by either elevating the limb or employing a protective cradle around the limb to prevent any pressure. Implore them to perform range of motion exercises in order to prevent stiffness of the involved joints and loss of function.

For More Severe Cases Of Frostbite …
Patients who have frostbite injuries that are greater than first degree should be observed in a hospital. It is difficult to assess viability accurately from the initial gross appearance of the damaged part. You should observe such injuries over time, especially when you’re considering the possibility of amputation. You should delay amputation as long as possible — sometimes weeks to months — in order to determine which tissues are truly necrotic and which are salvageable.

Triple-phase bone scanning has been used to define the extent of fatally damaged tissues in an attempt to allow for early debridement and wound closure. It is recommended that you perform the bone scan close to day two for all patients who present with lesions extending proximally to include the entirety of one or more phalanges. In the case of severe sepsis, the results of the first bone scan can serve as an indication for emergency amputation.
You should perform a second bone scan close to day eight if there is an area of low or absent uptake on the first bone scan. This can provide valuable information on the efficacy of treatment. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) can also provide valuable information for early intervention in cases of severe frostbite.
The use of pentoxifylline to minimize tissue damage in the treatment of frostbite has also been recommended. The suggested dosage of pentoxifylline in controlled release tablet form is one 400 mg tablet three times a day with meals. The duration of treatment should be from two to six weeks.

Final Thoughts
Ultimately, the best way to treat frostbite is prevention. This requires awareness of not only the actual temperature but also the windchill factor (see chart above). Athletes should dress in layers, which allows sweat to evaporate and protects against the cold. Wool, Gore-Tex and lycra are excellent materials to wear. Cotton is the worst. It will actually retain lots of moisture and facilitate heat loss due to convection.
It is also important to keep clothing and the inner surface of shoe gear dry in order to avert subsequent chilling from moisture next to the body. If an athlete feels that his or her body part is getting cold, he or she should move it continually, being careful not to keep it in one position for a long time. Jumping up and down and jogging in place are good sideline exercises. Adequate nutrition and hydration status are also essential.

Dr. Caselli (pictured) is Vice-President of the greater New York Regional Chapter of the American College of Sports Medicine and is a Professor in the Dept. of Orthopedic Sciences at New York College of Podiatric Medicine.




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