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Open Access Case report

Purtscher’s retinopathy after intramedullary nailing of a femoral shaft fracture in a 20-year old healthy female – report of a rare case and review of the literature

Reinhold Ortmaier1*, Herbert Resch1, Caroline Stieböck2, Ottokar Stundner3 and Eva Maria Arlt2

Author Affiliations

1 University Clinic for Trauma Surgery and Sports Injuries, Müllner Hauptstraße 48, Salzburg A-5020, Austria

2 University Clinic for Ophthalmology, Müllner Hauptstraße 48, Salzburg A-5020, Austria

3 University Clinic for Anesthesiology, Müllner Hauptstraße 48, Salzburg A-5020, Austria

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BMC Musculoskeletal Disorders 2014, 15:42  doi:10.1186/1471-2474-15-42

Published: 19 February 2014

Abstract

Background

Purtscher’s retinopathy is a sight threatening, occlusive microvasculopathy associated with trauma, it is rarely reported after long bone fractures.

Case presentation

A 20-year-old female sustained a femoral shaft fracture (AO 32-A2.3) in a ski accident colliding with a snowgun and was treated with intramedullary nailing one hour after the accident. 14 hours after surgery the patient complained of loss of vision in both eyes and was therefore referred to a neurologist, furthermore an MRI scan of the brain was performed. Neither showed any pathological findings. The patient was finally transferred to an ophthalmology department. After slit lamp examination and funduscopy Purtscher’s retinopathy was diagnosed. Treatment was started right after diagnosis and 5 days after the onset of symptoms. The patient was administered intravenous haemo-rheologic therapy for five days as well as low molecular heparine in therapeutic dose and Vasonit® 400 mg bid orally.

At follow-up 4 weeks and 6 months later visual acuity had improved after 4 weeks before that exam. At final follow-up the symptoms had almost resolved completely and uncorrected visual acuity (UCVA) and best corrected visual acuity had improved from originally 0.25 decimal in both eyes to 0.8 decimal UCVA and BCVA in both eyes.

Conclusions

Patients suffering from perioperative loss of vision have to be referred for ophthalmological and neurological assessment as soon as possible. History of trauma and visual loss can point to the diagnosis of Purtscher’s retinopathy.