Fracture neck of femur in haemophilia A – experience from a cohort of 11 patients from a tertiary centre in India

Abstract

We describe here the management of eleven patients with fracture neck of femur. Excepting one patient all had severe haemophilia A. Nine patients were less than 50 years of age. Eight out of eleven patients had fracture after trivial trauma. Nine patients had closed reduction and one patient open reduction. The patient with non union had a Valgus osteotomy. All fractures united. The average time to union was 11 weeks (range:8-16). We followed either a low dose intermittent or a low dose continuous infusion factor support protocol for the management of these patients. The median dose of factor support was 252 u/kg (range: 136-580). The average duration of factor support was 9 days (range: 7-10). Two patients had aggravation of pre existing knee stiffness following post operative immobilisation. No other major complication was observed in this cohort of patients. To conclude, management of fracture neck of femur in patients with haemophilia is no different from general population if an adequate haemostasis is achieved.

Bleeding disorders and reduced bone density

“…Reduced bone density in individuals with haemophilia is multi-factorial and if occurs during childhood phase, it is a major risk factor for acquisition osteopenia or osteoporosis in later of life [22]. RBD in severe haemophilia A is a concept which has been supported by several authors [3-5, 7, 11-18].…”

Hemophilia Care in India: A Review and Experience from a Tertiary Care Centre in Uttar Pradesh

“…This deficiency results in recurrent bleeds into joints S. Phadke (&) Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India e-mail: shubha@sgpgi.ac.in and muscles, leading to hemophilic arthropathy and contractures [1].…”

Haemophilia and low bone mass. Ok, but what about fracture risk?

“…It is interesting that in most cases, fractures in PWH occur after minor trauma, such as a fall from a standing position, which are not common in the general population of these ages . Interestingly, this was also reported for femoral neck fractures . Stress fractures (i.e.…”

“…The average age at the time of sustaining a fracture is 28–30 years in PWH . Most common fracture sites in PWH are the lower limbs and, in particular, femur (mainly shaft and less frequently supracondylar and neck sites) and, to a lesser extent, tibia .…”