Management of bleeding and associated complications of hemophilia in the hand and forearm.

Hemorrhage into the hand and forearm in hemophiliacs can be devastating if not treated early and properly. Of 200 hemophiliacs followed from 1969 to 1976, thirty-four had lesions of the hand and forearm. Hemarthrosis, the most common musculo-skeletal manifestation of hemophilia, occurred in the wrist and hand on only ten occasions. Superficial hemorrhage in the seven cases seen was not followed by significant sequelae. Bleeding into the anterior muscles and into the volar aspect of the wrist, on the other hand, was complicated by contracture, neuropathy, or both in six cases. Early diagnosis, replacement of the missing clotting factor, and immobilization are essential. Fasciotomy should also be considered, though it was not done in this series. Once a Volkmann's contracture is established, surgical reconstruction is required. The fractures in the hemophiliacs in this series, as in others, healed with normal periosteal callus formation and at a normal rate. Pseudotumors of the small bones of the hand have been described but were not seen in this series. Conservative therapy is suggested. After appropriate hematological evaluation to identify the missing factor and to exclude the presence of antibodies, it is now possible to control bleeding while proceeding with the necessary treatment to restore function and prevent deformity.