A, Preoperative radiograph of severe hemophilic arthropathy and painful swollen ankle. B and C, Postoperative radiographs of cross-threaded screw fixation. At 6 months, distal tibial pain and stress fracture are noted. D, At 12 months, stress fracture callus is noted but no pain. E, At 24 months, there is solid fusion. Stress fracture has resolved.