Frostbite is a cold thermal injury which usually affects the extremities and has the potential of causing irreversible and potentially life changing tissue loss. The understanding and treatment of freezing cold injuries to the periphery has advanced substantially in the last 10 years and optimal outcomes are only likely to be achieved if a multi-disciplinary team uses the full range of diagnostic and treatment modalities that are now available. The internet and satellite phones with digital images allow immediate access by patients from remote geographical locations to hospital based specialists who can assess cold injuries and advise on early field care. The severity of frostbite injuries can now be assessed with triple phase bone scanning, allowing early prediction of likely subsequent tissue loss. Newer thrombolytic therapies have transformed treatment options when instigated at an early time point. Non-freezing cold injuries were historically associated with military working in the field, but more recently it has been recognised the number of civilian cases has increased. Sustained exposure to cold, wet conditions often associated with immobility appear to be key risk factors. It remains an avoidable major source of longer term often neurological morbidity. The exact pathophysiology of non-freezing cold injuries remains poorly understood, but there have been some significant advances in our understanding in certain areas recently.