Orthopedics - Oleksa A.P. 2006

Occupational musculoskeletal disorders
Cold-induced bone injuries

In occupational pathology, chronic frostbite has gained particular significance, typically affecting fishermen, log drivers, hunters, meat-packing workers, construction installers, ice-house workers, and refrigeration plant operators.

Exposure to low temperatures and high humidity also induces complex pathological Changes in the bones. For instance (Aryev T.A., 1948), in first-degree frostbite—where only the upper layers of the epidermis are affected and hyperemia is reversible—bone Osteoporosis is observed. Second-degree frostbite, characterized by blister formation, leads to osteoporosis and focal rarefaction (bone resorption). Third-degree frostbite presents with osteomyelitic changes, while fourth-degree frostbite involves a combination of lytic, necrotic, and destructive processes, pathological fractures, and Osteomyelitis.

The initial radiological signs appear after two to three weeks. Over time, osteoporosis and focal bone rarefaction may disappear completely.

In chronic frostbite, edema and cyanosis become persistent features as long as exposure to cold and humidity continues. Clinical symptoms of bone alterations manifest significantly later than radiological findings. Progressive, ascending osteoporosis indicates the severity of the cold injury.

Patients with third-degree frostbite require surgical intervention, whereas fourth-degree frostbite ultimately necessitates the amputation of the affected segments (such as fingers, toes, etc.).

In occupational thermal Burns of degrees II–IIIA among workers in hot shops of metallurgical plants, glassworks, and brick factories, radiological examination reveals osteoporosis in the affected areas, predominantly in the distal PARTS OF THE extremities.