Bone Fractures in People with Hemophilia

Document Type : In Brief

Author

Department of Orthopaedic Surgery, La Paz University Hospital, Madrid, Spain

10.22038/abjs.2025.85841.3907

Abstract

The existing literature on bone fractures in people with hemophilia (PWH) states that they should be treated in the same way as in healthy individuals but with perioperative hemostasis control through intravenous infusion of the deficient coagulation factor (factor VIII in hemophilia A, factor IX in hemophilia B) at appropriate doses and for the necessary duration. It has also been found that fractures in PWH are more frequent than in normal individuals, probably due to suffering from osteoporosis. The healing time for fractures in PWH is similar to that of the general population. It should be noted that some fractures in PWH are pathological due to the presence of hemophilic pseudotumors that cause erosion of the affected bone. These fractures should also be treated as pathological fractures of any other etiology. Finally, the risk of acute compartment syndrome associated with bone fractures in PWH should never be forgotten.
        Level of evidence: III

Keywords

Main Subjects

References

  1. Mortazavi SM, Heidari P. Retrograde intramedullary nailing of supracondylar femoral fractures in haemophilic patients. Haemophilia. 2008; 14(3):661-664. doi: 10.1111/j.1365-2516.2008.01742.x.
  2. Rodriguez-Merchan EC. What´s new in orthopedic surgery for people with hemophilia. Arch Bone Jt Surg. 2018;6(3):157-160.
  3. Boni M, Ceciliani L. Fractures in haemophilia. Ital J Orthop Traumatol. 1976;2(3):301-310.
  4. Tozzi E, Castellacci E, Bottai M. [The prognosis of fractures in hemophiliacs has improved]. Arch Sci Med (Torino). 1978;135(1):87-89.
  5. Boardman KP, English P. Fractures and dislocations in hemophilia. Clin Orthop Relat Res. 1980;148:221-232.
  6. Wolff LJ, Lovrien EW. Management of fractures in hemophilia.

 

         Pediatrics. 1982;70(3):431-436.

  1. Markakis P, Papajoannou N, Kambouruglou G. [Fractures in hemophilia patients]. Unfallchirurgie. 1984;10(4):173-176. doi: 10.1007/BF02585724.
  2. Ishiguro N, Iwahori Y, Kato T, et al. The surgical treatment of a haemophilic pseudotumour in an extremity: a report of three cases with pathological fractures. Haemophilia. 1998;4(2):126-131. doi: 10.1046/j.1365-2516.1998.00163.x.
  3. Pruthi RK, Heit JA, Green MM, et al. Venous thromboembolism after hip fracture surgery in a patient with haemophilia B and factor V Arg506Gln (factor V Leiden) Haemophilia. 2000;6(6):631-634. doi: 10.1046/j.1365-2516.2000.00431.x.
  4. Rodriguez-Merchan EC. Bone fractures in the haemophilic patient. Haemophilia. 2002;8(2):104-111. doi: 10.1046/j.1365-2516.2002.00628.x.
  5. Lee VN, Srivastava A, Nithyananth M, et al. Fracture neck of femur in haemophilia A - experience from a cohort of 11 patients from a tertiary centre in India. Haemophilia. 2007;13(4):391-394. doi: 10.1111/j.1365-2516.2007.01448.x.
  6. Leblanc J, Puloski S, Hildebrand K. Interprosthetic humeral fracture revision using a tibial allograft total elbow prosthetic composite in a patient with hemophilia A : a case report. J Med Case Rep. 2012;6:319. doi: 10.1186/1752-1947-6-319.
  7. Anagnostis P, Vyzantiadis TA, Charizopoulou M, et al. The effect of monthly ibandronate on bone mineral density and bone turnover markers in patients with haemophilia A and B and increased risk for fracture. Thromb Haemost. 2013;110(2):257-263. doi: 10.1160/TH13-01-0030.
  8. Lin J, Liu H, Liu P, Yang H. External fixators for open fractures of tibia and fibula in patients with haemophilia A. Haemophilia. 2015;21(1):e51-e53. doi: 10.1111/hae.12538.
  9. Huang W, Wang TB, Zhang P, et al. [Characteristics and perioperative management of hemophilia patients with fractures]. Beijing Da Xue Xue Bao Yi Xue Ban. 2015;47(2):281-4.
  10. Candiotto L, Fullone FW, Ricciardi A, Radossi P, Tagariello G. Correction of knee flexion contracture at the time of surgical fixation of a femoral supracondylar fracture in a haemophiliac with inhibitors. Blood Transfus. 2015;13(2):333-335. doi: 10.2450/2014.0149-14.
  11. Anagnostis P, Karras S, Paschou SA, Goulis DG. Haemophilia A and B as a cause for secondary osteoporosis and increased fracture risk. Blood Coagul Fibrinolysis. 2015;26(6):599-603. doi: 10.1097/MBC.0000000000000330.
  12. Caviglia H, Landro ME, Galatro G, Candela M, Neme D. Epidemiology of fractures in patients with haemophilia. Injury. 2015;46(10):1885-1890. doi: 10.1016/j.injury.2015.06.034.
  13. Gay ND, Lee SC, Liel MS, Sochacki P, Recht M, Taylor JA. Increased fracture rates in people with haemophilia: a 10-year single institution retrospective analysis. Br J Haematol. 2015;170(4):584-586. doi: 10.1111/bjh.13312.
  14. Strauss AC, Pennekamp PH, Placzek R, et al. Perioperative management and outcome of fracture treatment in patients with haemophilia without inhibitors. Haemophilia. 2016;22(1):e30-e35. doi: 10.1111/hae.12803.
  15. Reynolds JM, Christophersen C, Mulcahey MK. Acute compartment syndrome after an olecranon fracture in a patient with mild hemophilia B. J Orthop Case Rep. 2017;7(2):98-101. doi: 10.13107/jocr.2250-0685.770.
  16. Tuan SH, Hu LY, Sun SF, et al. Risk of osteoporotic fractures as a consequence of haemophilia: A nationwide population-based cohort study. Haemophilia. 2019;25(5):876-884. doi: 10.1111/hae.13814.
  17. Chen K, Jiang G, Xu Y, et al. Surgical treatment for patients with hemophilic pseudotumor-related femoral fracture: a retrospective study. J Orthop Surg Res. 2021;16(1):275. doi: 10.1186/s13018-021-02426-1.
  18. Pai YY, Wang JD, Ho HE, et al. Risk of fractures, repeated fractures and osteoporotic fractures among patients with hemophilia in Taiwan: a 14-year population-based cohort study. Int J Environ Res Public Health. 2022;20(1):525. doi: 10.3390/ijerph20010525.
  19. Alito A, Bellone F, Portaro S, et al. Haemophilia and fragility fractures: from pathogenesis to multidisciplinary approach. J Mol Sci. 2023;24(11):9395. doi: 10.3390/ijms24119395.
  20. Ransmann P, Hmida J, Brühl M, et al. The influence of severity of hemophilia on bone mineral density and fracture risk. Res Pract Thromb Haemost. 2024;8(8):102624. doi: 10.1016/j.rpth.2024.102624.
  21. Poston JN, Kruse-Jarres R. Perioperative hemostasis for patients with hemophilia. Hematology Am Soc Hematol Educ Program. 2022;2022(1):586-593. doi: 10.1182/hematology.2022000387.
  22. Alvarez-Roman MT. Hemostatic cover in orthopedic surgery. Blood Coagul Fibrinolysis. 2023;34(S1):S22-S25. doi: 10.1097/MBC.0000000000001201.
  23. Carulli C, Innocenti M, Porciatti T, Castellani N, Pieri L, Civinini . Fractures needing orthopaedic surgery in haemophilic patients: long-term experience of a dedicated team at a single institution. Int J Bone Frag. 2021;1(1):17-22. Doi:10.57582/IJBF.210101.017.

 

 

 

 

 

The Archives of Bone and Joint Surgery
Volume 14, Issue 6
June 2026
Pages 408-416

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History

  • Receive Date: 04 February 2025
  • Revise Date: 13 April 2025
  • Accept Date: 14 April 2025

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