Fractures and dislocations in hemophilia

Twenty-two patients with hemophilia A were successfully treated for fractures and dislocations without complication in the last 10 years, with the aid of recently developed methods of maintaining hemostasis, and conventional methods of reduction and immobilization. Most injuries were managed "conservatively," but 4 patients had operations. All the injuries healed in average time. A factor VIII level of 30% was maintained for the first 2 to 4 days for stable fractures and for 5 to 7 days for unstable fractures, but patients requiring operations were covered to a level of 60% for 2 weeks. Factor VIII concentrates were not given to 2 patients with inhibitors. Excessive bleeding occurred in one of the patients with inhibitors and in another in whom replacement therapy was delayed, but bleeding was not a problem in the remaining patients.