Case Report: Fractured femur head in
young rabbit
Is it possible to avoid amputation
in this case ?
Sorelle Saidman - 
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Neil was a
rescue from the University of Victoria campus in Victoria, BC, Canada, where
close to 1,000 rabbits were scheduled for "extermination." All rabbits have now been safely
evacuated. Neil was discovered in a thicket along a roadside,
approximately eight weeks old, with a left rear leg that extended
perpendicularly from his body. A
visiting veterinarian had spotted the little guy and suggested it was likely
a crush injury. Neil was referred to a veterinarian in Vancouver, who
recommended immediate amputation. I hesitated, as the rabbit was malnourished
and infected with roundworms and hookworms.
I decided to improve his physical condition before resorting to
surgery. no signs of discomfort were noted in the limb. The decision was made
to postpone the surgical procedure.
He was
subsequently relocated to a different foster home, and my decision was
brought into question by my fellow rescuers.
There was a divergence of opinion regarding the nature of the injury,
with some suggesting it was a genetically splayed leg and others an injury.
The preferred course of treatment was also a topic of debate, although most,
if not all, suggested amputation. Two months after the rescue, a rescuer noticed that
the animal appeared to be acting a bit lethargic. Therefore, he brought the
animal to another veterinarian for evaluation.
Note:
X-rays were taken by different veterinary technicians that were just giving
us the free x-rays on their own time (with permission of course) and we gave
those pictures to the vets.
New X-rays
were taken and shared with the veterinarians and veterinary technicians at
the clinic. One noted that the bone appeared to be compromised, while another
suggested that the femur was being "eaten" and exhibited signs
consistent with cancer or infection. Another veterinarian also mentioned
osteomyelitis as a potential diagnosis. All parties
involved recommended that immediate amputation be performed. How to proceed with such
different opinions ?
At this
point, I sent the X-rays to MediRabbit. The rabbit could not be seen
physically, but it was determined that the problem appears likely to be the
result of a crush or a traumatic injury with detachment of the femur head and
displacement of the femur head, accompanied by bone regrowth/malunion. Neil rabbit
would need: 1. A proper physical examination; 2. X-rays taken while rotating and pulling the
affected hind limb, on a fully anesthetized rabbit; 3. Blood test (CBC) to rule out the presence
of an active infection, e.g., osteomyelitis; 4. Bone biopsy, to help determine the nature
of the mass, if head of the femur or tumor. If the mass
is determined to be the head of the femur along with bone regrowth or
malunion, it is essential to assess for the presence of pain and any
limitations in movement. If not, the rabbit can continue this way. If the
mass is determined to be the head of the femur along with bone regrowth or
malunion, it is essential to assess for the presence of pain and any
limitations in movement. If not, the rabbit can continue this way. If the
issue is causing movement disturbance and/or pain, an orthopedic surgeon
should be consulted to discuss treatment options, which may include removing
the femoral head while preserving the femur. Amputation ? Amputation
is a significant surgical procedure. This appeared to be a pre-existing
injury, and the bunny's leg did not appear to be causing him any
discomfort. I decided to wait. Some
people have expressed concerns about this decision. They have accused me of
negligence, claiming that the X-rays indicate infection or cancer, and that
amputation is necessary. I have
always been hesitant when it comes to treating broken bones in rabbits. I
have witnessed numerous surgical interventions involving the use of pins and
rods that have resulted in complications, and in many cases, injuries have
healed spontaneously without intervention. Consequently, amputation has been
regarded as the less detrimental option. While I concur that three-legged
rabbits can thrive and that amputation surgery is not a significant risk, I
acknowledge that we may be somewhat hasty in opting for it. Is amputation
the most likely ‘for sure’ for Neil rabbit ?
After
sending the X-rays to MediRabbit for consultation, the answer was that limb
amputations were done too frequently, without considering possible long-term
side effects of bearing weight and/or wrong positioning on the other hind
limb in aging amputated rabbits. In the absence of infection or mass, and
provided the limb with the broken, malunited, or nonunion bone has remained
functional and the rabbit has adapted and is ambulating well without pain, why
sacrifice this limb ? Risks when leaving the
malunion bone heal ?
In the
long term, there is a possibility of developing pododermatitis, lameness,
degenerative joint disease or arthritis, or ankylosis of a joint due to slow
destruction of cartilage and/or bone. Outcome
I
consulted with my own veterinarian, who had initially recommended amputation.
He concurred that the bones were knitting, but nevertheless recommended the
amputation procedure again. The rabbit
was taken in for the surgery, albeit reluctantly. He was prepared for anesthesia when my
veterinarian conducted a follow-up examination and found no signs of pain
response in the leg. He decided against
performing the operation. Two or three months later, the rabbit is
a happy, healthy, and active little guy.
His leg is positioned laterally, and on occasion, it comes into
contact with an object, though this does not cause him discomfort. Amputation
is a destructive surgical procedure that should be considered only as a last
resort. It is not an alternative, even if prognosis is usually good and
rabbits adapt well.
Acknowledgement
I would like
to express my sincere gratitude to MediRabbit (Switzerland) and Dr. Amir
Maurer (Israel) for their diligent review of the X-rays. Their counsel was
instrumental in averting the need for amputation surgery on this rabbit. |
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