Femoral Fractures in Severe Hemophilia

Abstract

Increasing physical activity of hemophilic children has resulted in more frequent fractures. Within the last ten years, fourteen severe hemophiliacs (8-19 years)sustained femoral fractures. Four of these hemophiliacs had an inhibitor. Eight were the result of minimal trauma. There was no obvious correlation in these eight cases with prolonged immobilisation and/or treatment with steroids. Co-existing knee hemarthrosis or thigh hematoma often led to a delay in the diagnosis of the fracture. Metaphyseal fractures(8 cases) were treated by plaster cast (4) or, skin or pin traction (4) with good anatomical result and normal union. Replacement therapy was given in 3 cases for 3 days and in 1 case for 2 weeks. No complication occurred in any of the non transfused patients(4). Epiphyseal and femoral shaft fractures were treated by skin or pin traction (3) or internal plate fixation (2)associated with replacement therapy for at least 2 weeks. Unsatisfactory anatomical result was obtained in three cases. One impacted fractured neck of femur was discovered on X-ray examination 3 weeks after trauma. Guide lines for orthopedic and medical treatment of femoral fractures in hemophiliacs are suggested according to the anatomical feature.