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Ischemic Optic Neuropathy Following Surgical Fixation of Multiple Ipsilateral Upper-Extremity FracturesA Case Report
Richard L. Davis, II, MD1; Jason R. Ferrel, MD1; Benjamin C. Taylor, MD2; T. Ty Fowler, MD1
1 Department of Orthopaedic Surgery, Mount Carmel Health, 793 West State Street, MSB 3rd Floor, Columbus, OH 43222. E-mail address for R.L. Davis: davislrick@gmail.com.
2 Department of Orthopaedic Surgery, Grant Medical Center, 285 East State Street, Suite 500, Columbus, OH 43215.
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Investigation performed at Mount Carmel Health, Columbus, Ohio



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Case Connector, 2013 Aug 14;3(3):e78 1-5. doi: 10.2106/JBJS.CC.L.00131
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Extract

Postoperative vision loss is a rare but devastating surgical complication. Ischemic optic neuropathy (ION) is one such form of vision loss, most commonly recognized with prone positioning in spinal surgery. It is also documented as a complication of multiple surgical specialties, including general orthopaedics1, otolaryngology2, obstetrics and gynecology3, cardiothoracic surgery4,5, and general trauma surgery6. ION is an acute ischemic disorder that causes blindness, with reported postoperative incidence ranging from 0.013% to 1.3%5,7-9. Blood flow to the optic nerve is autoregulated and is dependent on ocular perfusion pressure (OPP). OPP can decrease to a level beyond which autoregulation mechanisms can compensate10, leading to ischemic injury. The most common associated risk factors for this complication are often encountered in orthopaedic trauma, namely length of surgery11 and intraoperative arterial hypotension6,8. To our knowledge, ION has not previously been reported in the orthopaedic trauma literature. We present the case of a fifty-year-old man who developed ION after internal fixation of ipsilateral fractures of the proximal part of the humerus and olecranon. The patient was informed that data concerning the case would be submitted for publication, and he provided consent.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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