Management of fractures in hemophilia

Nine patients with hemophilia A suffered 16 fractures. Four patients had severe hemophilia (factor VIII <1%) and five had moderate or mild hemophilia (factor VIII between 4% and 25%). Two patients developed skeletal pseudotumors after their fractures. One patient developed neurapraxia. Fractures in hemophiliacs should be treated promptly with 25 units/kg/day of factor. Fractures of the upper limb should be maintained at this dose for seven days; lower extremity fractures should be treated with factor for 14 days. Orthopedic management should be the same as used for nonhemophiliacs. Skeletal pseudotumors should be managed with prolonged factor administration and immobilization until radiographic evidence of healing occurs.