Sub-trochanteric Femoral Fracture in a Young Hemophilia A Patient and its Management

Introduction Hemophilia is an X linked recessive chromosomal bleeding disorder in which there is an anomaly in synthesis of clotting factors. These patients experience heavy episodes of bleeding even from minor cuts. Hemophilia is a condition of great interest for orthopedic surgeons due to its clinical manifestations. Our aim is to present a case of hemophilia A with proximal femoral fracture and its management. Case presentation An eighteen-year-old boy with Hemophilia A, who presented after a road traffic accident at a hospital, where he was managed by fresh frozen plasma (FFP) and blood transfusion. His treatment was delayed due to unavailability of factor VIII at hospital and his family arranged it on their own. His surgery planned after 2 days of admission, internal fixation by cephalomedullary nailing was done. Discussion Hemophilia diagnosis involves a combination of factor VIII level assays and abnormal bleeding episodes in the patient. The treatment involves prophylactic administration of factor VIII. In case of femoral fractures in these patients, intramedullary nailing is preferred while maintaining the levels of factor VIII at the same time. Conclusion Management of fracture in this hemophilia patient was a difficult task. Early presentation at the hospital had a positive while unavailability of recombinant factor VIII concentrate on time had a negative impact on the outcome.