External fixators in haemophilia

External fixators (EF) are not commonly used for patients with haemophilia. We describe the use of EF (Ilizarov, AO‐ uni‐ and bi‐planar fixators and Charnley clamp) in nine patients (mean age: 19.2 years; range: 9–37) with haemophilia for the following indications – arthrodesis of infected joints, treatment of open fractures and osteoclasis. EF required an average of nine skin punctures [range: 4–17 were maintained for a period of 15 weeks (range: 8–29.5), without regular factor replacement, till bone healing was adequate and were removed with a single dose of factor infusion]. The mean preoperative factor level achieved was 85% (range: 64–102%). Much lower levels were subsequently maintained till wound healing. The average total factor consumption was 430 IU kg−1 (range: 240–870), administered over a period of 17 days (range: 9–44). There were no major complications related to EF except in a patient who developed inhibitors. In conclusion, EF can be used safely in haemophilic patients who do not have inhibitors and does not require prolonged factor replacement.