Mandatory to undergo Surgical treatment for patients with He
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In patients with HPTs, a fracture linked to the hemophilic pseudotumor (HPT) is an uncommon but serious complication. The femur is prone to these fractures. For HPT-related femoral fractures, there is no specific surgical protocol.

The results of these patients who underwent surgical intervention were analyzed in this retrospective review. 10 patients with HPT-related femoral fractures who were treated with 14 surgical procedures due to 11 fractures were evaluated retrospectively. Demographic data, fracture location, complications after surgery, and follow-up outcomes were recorded and analyzed. The mean follow-up period was 39.7 months.

The mean age at surgery was 31 years.
--Closed reduction external fixation (CREF) was originally performed in 2 patients, open reduction internal fixation (ORIF) was performed in 4 patients, screw fixation alone was performed in 1 patient, brace immobilization was performed in 1 patient, and amputation was performed in 3 patients.

--Bone union was observed in 5 patients, and an adequate callus was visible in 2 patients.

--Both patients with CREF had pin infections. Nonunion combined with external fixation (EF) failure occurred in 1 patient, and the plate was broken after ORIF.

--3 patients underwent autogenous or allogeneic cortical strut grafting. 3 patients had HPT recurrence.

In conclusion, surgery is needed in patients with HPT-related femoral fractures. Fracture stabilization and HPT resection must be considered in surgical procedures. Internal fixation is preferred, and EF should be used only as a last resort. Strut grafts are needed for mechanical stability if the HPT erodes more than one-third of the bone diameter. In some cases, amputation is an effective treatment option.