Most common cause of fracture in hemophilic arthropathy –
Correct Answer: Osteoporosis & restrictive joint movement
Description: Ans. is 'a' i.e., Osteoporosis & restrictive joint movemento There is increased susceptibility of fractures in patients with hemophilic arthropathy : -Although the reported cases are few in number it is believed that hemophiliacs are more susceptible to fractures because of the limitation ofjoint movement poor muscle function and osteoporosis.The most surprising feature of fracture in hemophiliacs patients is that union is not delayed despite the osteoporosis and the absence ofplama clotting factors.o Arthropathy is a frequent and serious complication of repeated joint bleeding in patients with hemophilia .o Hemarthrosis is the single most important risk factor for the development of hemophilia arthropathy.o Eighty percent of joint bleeding episodes involve the knees.elbows and ankles and the patient most often devlop multiple target joints (the joints that are most commonly affected with repeated bleeding in an individual patient),o Approximately 50% of patients with hemophilia develop permanent changes in the target joint,o The presence of blood in a joint triggers an inflammatory-' process that results in joint swelling and decreased range of motion.o Although blood rapidly clears from the joint space, the pathological process continues, resulting in both radiographical and clinical changes, Progressive joint damage results in muscle atrophy, osteoporosis, cartilage degeneration with collapse of joint space and cyst formation.ARNOLD-HIL GARTENER CLASSIFICATION OFHEMOPHILLICARTHROPATHYSTAGECHARACTERISTICSIo No visible skeletal deformities o Soft tissue swelling secondary to hemarthrosis or bleeding into the soft tissue in and around joint.IIo Osteoporosis,especially in epiphyses and their overgrowth. o Joint integrity maintained with no narrowing of cartilage space and no bone cyst.IIIo Presence of disorganisation of joint but no significant narrowing of cartilage space o Synovium may be opacified with hemosiderin deposin.IVo Narrowing of joint space and evidence of cartilage destruction in addition to stage III changesVo Fibrous joint contracture,loss of joint space extensive enlargement of epiphyses and substantial disorganisation of joint structures. o Marked restriction of joint motion o Little recognisable synovial tissue found when joint is opened, o Absence of articular cartilage.
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