A Common Complication of Haemophilia

This paper describes and seeks to explain a clinical syndrome which occurs characteristically, but not exclusively, as a complication of haemophilia. The main features of the syndrome are the sudden onset of severe pain in the groin accompanied by marked flexion deformity at the hip, followed by a mass in the iliac fossa and femoral nerve palsy. Episodes of this sort have been reported in the literature since the publication of Getting’s case by Bulloch and Fildes in 191 1 . We have found only fourteen published cases since then (Gunther 1924, 1935 ; Seddon 1930 ; Tallroth 1939 ; Aggeler and Lucia 1944 ; Weil 1946 ; Lyons 1953; Douglas and McAlpine 1956; Hall 1961). The syndrome is common in haemophiliacs: of forty patients studied by Davidson, Epstein, Miller and Taylor (1949) no less than fifteen had suffered at least one such episode. The syndrome has usually been attributed to haemorrhage into the psoas muscle, and Weil (1946) considered this the commonest site of intramuscular haemorrhage in haemophilia. We have studied twenty-four patients, eleven of whom were admitted to the Nuffield Department of Orthopaedic Surgery for treatment of this syndrome from 1962 to 1965. The other thirteen had been treated elsewhere and were examined by one of us. We believe that the syndrome results from haemorrhage into the iliacus muscle.