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Evaluation of Skin Temperature in Cold Sensitivity after Fracture
Christine B. Novak, PT, PhD; Yue Li, PhD; Steven J. McCabe, MD; Geoff Fernie, PhD
University of Toronto, Toronto, ON, Canada

Purpose: The mechanisms related to abnormal cold sensitivity after hand trauma remain unknown and previous studies have indicated no change in digit skin temperature with cold sensitivity. The purpose of this study was to evaluate skin temperature responses with cold air exposure using continuous temperature monitoring in patients with cold sensitivity following hand fractures.
Methods: Adult patients with hand fractures more than 3 months after injury were evaluated. Using a validated protocol, cold air exposure was produced in a climate laboratory (1C for 20 minutes) with baseline and recovery periods (20 minutes) at room temperature. Continuous skin temperatures were monitored by placing thermistor tips in direct contact with the skin on the dorsum of each middle phalanx to compare the injured and uninjured digits. The temperature data were collected with a data logger at a sampling rate of 8-second intervals during baseline, cold air exposure and recovery. Statistical analyses evaluated the relationships between the injured and uninjured hands and fracture location (distal vs. middle phalanx).
Results: Our preliminary data included four patients with hand fractures (distal phalanx n = 2, middle phalanx n = 3). There was a similar pattern of cooling in all digits with lower skin temperatures in the injured digits in 4 of 5 fractures. With cold exposure, the mean lowest skin temperature of the injured digits was 15.2 2.5C (range 17.9-12.1C ) and of the uninjured digits was 17.0 3.6C (range 21.4-12.5C ) which indicated wide variability in baseline and cold exposure skin temperatures. Comparison between injured and uninjured fingers showed significantly lower skin temperatures in distal phalanx fractures (p = 0.01). The mean difference between hands (injured vs uninjured) was significantly greater (p = 0.01) for distal phalanx fractures (4.1 .13C) compared to middle phalanx fractures (.25 .87C).
Conclusions: Our preliminary data indicated variability in the cold air responses following hand fractures. There were significant decreases in skin temperature in digits with cold sensitivity after hand fracture and these skin temperature changes were most evident with distal phalanx fractures. These results indicate that cold air exposure with continuous temperature monitoring may be a superior method to induce cold stress and to identify subtle physiologic changes associated with cold sensitivity. Future study is needed to evaluate skin temperature changes in a larger sample of patients and the relationship to self-report in cold sensitivity following hand trauma.

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