Introduction <p>Heterotopic ossification (HO), soft-tissue ossification due to muscle trauma, is fairly common in individuals with hemophilia, but uncommon in the pediatric age group. Bridging ankylosis is even rarer.</p> Case Presentation <p>We report the case of an 11-year-old boy with moderate hemophilia A who presented with atraumatic complete left elbow ankylosis, following complaints of spontaneous swelling and stiffness and two instances of massaging and bandaging over a 4-year period. Radiography was suggestive of heterotopic ossification forming a bony bar, or bridge, and surgical excision was performed with recombinant factor 7 and Emicizumab coverage. Histopathology confirmed the diagnosis, and physiotherapy ensured reasonable functional recovery in the immediate postoperative period and the first week. The patient developed a hematoma on the seventh postoperative day, extending from the suture site to the periosteum in the intermuscular plane. Alterations to his postoperative regimen and careful monitoring ensured hematoma resolution.</p> Conclusions <p>HO is underreported, and it is unsurprising that there is also little literature on evidence-based guidelines for surgical excision and managing potential hematomas. This paper aims to highlight a case of clinical interest with bridging ankylosis and no history of trauma and consolidate insights from existing literature on diagnosis, management, and the pitfalls of attempting surgical repair in low-resource settings with poor patient compliance. We focus on post-operative complications affecting functionality and potential recurrence in such environments.</p> <p>Level of Evidence: 4</p>