A Case of Mild Hemophilia A Requiring Open Reduction Due to Subperiosteal Hematoma after Tibial Fracture

• Published in: The Japanese Journal of Pediatric Hematology Vol. 17; no. 5; pp. 402 - 405
• Main Authors: TAKI, Masashi, KOBAYASHI, Miwako, OHI, Chiai
• Format: Journal Article
• Language: Japanese
• Published: THE JAPANESE SOCIETY OF PEDIATRIC HEMATOLOGY/ONCOLOGY 2003; 特定非営利活動法人 日本小児血液・がん学会
• Subjects: bone fracture; mild hemophilia A; subperiosteal hematoma
• ISSN: 0913-8706; 1884-4723
• DOI: 10.11412/jjph1987.17.402

This paper reports a case of mild hemophilia A in which the lack of appropriate hemostatic management after tibial fracture caused subperiosteal hematoma formation, thus necessitating open reduction. A 6-year-old boy, diagnosed as having a fractured right tibia, received two doses of desmopressin acetate (DDAVP) and his broken leg was splinted and plastered at another hospital on the day the injury occurred. Dislocation found in the lesion three weeks after the fracture was treated only with local cooling at the time of follow-up and the patient was discharged. He came to our hospital with persistent pain in the fractured area, which was then diagnosed as posttraumatic displacement in the lesion with subperiosteal hematoma. Since conservative treatment did not achieve synostosis, we conducted open reduction with removal of the hematoma while controling hemostasis by continuous administration of factor VIII preparation. The patient recovered after a favorable postoperative course without any complications. This case suggests the necessity for conducting appropriate hemostasis for patients with mild hemophilia because even if obvious subperiosteal hematoma is not found immediately after fracturing, it could be generated later, which might delay synostosis and induce pseudotumor formation.