Symmetrical epiphyseal destruction by frostbite.

There have been only single reports about the radiological changes in bones subsequent to frostbite in childhood and adolescence. We found only three cases on this subject in the literature. L6hr (1930) described a case in a 16-year-old boy; Bennett and Blount (1935) published the report of an 8-year-old girl, and Thelander (1950) of a 9-yearold boy. There are some thorough studies on this subject among adults, especially from the second World War (Appelrath, 1943) and the Korean War (Vinson and Schatzki, 1954). Jager (1943), from observations on soldiers, describes the following findings as specific for frostbite: smoothing of the tuberositas inguicuales, cartilage atrophy of the interphalangeal joints, small punched-out areas of decreased density in the juxta-articular joints, and small destructive changes in the cartilages of the joints and the surrounding bones, with secondary arthrosis deformans. Appelrath (1943) stresses the susceptibility of the cartilage to frostbite. He often found definite evidence of damage to the cartilage of the interphalangeal joints without radiological signs in the phalanges. He claims that the earliest radiological findings were the narrowing or disappearance of the articular spaces which were first noted after about two months. According to him, this was due to the difference in the vascular structure of the bones and the cartilage. In more severe cases there were necrotic changes in the bones. Later, secondary arthritic deformities appeared. A diffuse osteoporosis was often apparent. Vinson and Schatzki (1954) observed the bone changes occurring in a group of 100 enlisted men with frostbite. They classified the radiographic changes into four groups: (1) osteoporosis; (2) acromutilation (mutilation of terminal phalanges due to exposed bone); (3) late changes in the bones close to the joints of feet or hands, and (4) other bone changes.