Presentation of non freezing cold injury (NFCI)

presentation

Usually affected person will give a history of been cold and wet for a sustained period, often having been unable to dry out satisfactorily.

• most cases involve feet, injured hands may also feature in as many as 25% of cases.

Trench foot and other related conditions categorized under NFCI are caused by reduced blood flow to the limbs exposed to environmental conditions. Four distinct stages have been identified in the evolution of symptoms.

• stage 1 - injury or cold phase
  • presence of vasoconstriction with tissue being cold and numb
  • degree of local anaesthesia and loss of proprioception in the limb
  • limb may be bright red initially but later change to a paler colour, even completely blanched white
  • there is no pain or swelling
    
    
• stage 2 - immediate post injury
  • seen when the limb is warmed
  • colour will change from white to blue but remain cold and numb
  • may be associated with mild swelling and an absence of peripheral pulse
    
    
• stage 3 - hyperaemic phase
  • may last between 2 weeks to 3 months
  • limb becomes hot red with dry skin, painful and with a degree of paraesthesia
  • blistering and demarcation of the skin may be seen in severe cases
    
    
• stage 4 - post hyperaemic phase
  • may last for the rest of a patient's life
  • there may be increased sensitivity to the cold, hyperhidrosis and ongoing paraesthesia and pain
  • flexion contracture, claw deformities, muscle atrophy and ulceration may occur in severe cases (2)

Reference:

• (1) Imray C et al. Cold damage to the extremities: frostbite and non-freezing cold injuries. Postgrad Med J. 2009;85(1007):481-8.
• (2) Heil K et al. Freezing and non-freezing cold weather injuries: a systematic review. Br Med Bull. 2016;117(1):79-93.