Article Text

Download PDFPDF
Frostbite: a systematic review on freezing cold injuries in a military environment
  1. T T C F van Dongen1,2,
  2. R R Berendsen3,
  3. F J M de Jong4,
  4. E L Endert4,
  5. R A van Hulst5 and
  6. R Hoencamp1,2,6,7
  1. 1Defence Healthcare Organisation, Ministry of Defence, Utrecht, The Netherlands
  2. 2Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
  3. 3Department of Anaesthesiology, Leiden University Medical Centre, Leiden, The Netherlands
  4. 4Dive Medical Centre, Royal Netherlands Navy, Den Helder, The Netherlands
  5. 5Department of Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
  6. 6Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands
  7. 7Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
  1. Correspondence to Maj T T C F van Dongen, Defence Healthcare Department, Ministry of Defence, 3584 AB, Utrecht, The Netherlands; ttcfvandongen{at}


Background Military practice or deployment in extreme conditions includes risks, dangers and rare disorders. One of the challenges is frostbite; however, current literature does not provide an overview of this condition in a military context. This review aims to map the incidence, risk factors and outcome of frostbite in military casualties in the armed forces.

Methods A systematic literature search on frostbite (freezing cold injuries) in military settings from 1995 to the present was performed. A critical appraisal of the included articles was conducted. Data on incidence, risk factors, treatment and outcome were extracted.

Results Fourteen studies were included in our systematic review. Most studies of frostbite in a military setting were published nearly half a century ago. Frostbite incidence has declined from 7% to around 1% in armed forces in arctic regions but could be as high as 20% in small-scale arctic manoeuvres. Overall and military-specific risk factors for contracting frostbite were identified.

Conclusion During inevitable arctic manoeuvres, frostbite is a frequently diagnosed injury in service members. Postfreezing symptoms often persist after severe frostbite injury, which decreases employability within the service. Over time, military practice has changed considerably, and modern protective materials have been introduced; therefore, re-evaluation and future study in the military field are appropriate, preferably with other North Atlantic Treaty Organization partners.

  • altitude medicine
  • musculoskeletal disorders
  • trauma management
  • wound management
  • primary care

Data availability statement

No data are available.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors TTCFvD: planning, conducting, reporting/submission. RRB, FJMdJ: planning, conducting, reviewing. ELE, RAvH: conducting, reviewing. RH: planning, conducting, end review, guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.