Case report:
broken femur head in a young rabbit
Can amputation
be avoided ?
Sorelle Saidman
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Neil was a
rescue from the University of Victoria campus in Victoria, BC, Canada, where
close to 1000 rabbits were about to be ‘exterminated’. (All have now made it out safely). He was found living in a thicket by the side of a
road, just eight weeks old or so with a left rear leg that stuck out
perpendicular to his body. A visiting
veterinarian had spotted the little guy and mentioned it looked like a crush
injury. Neil was taken to a vet in Vancouver who recommended immediate
amputation. I hesitated, the rabbit was malnourished
and loaded with worms (roundworms and hookworms). I opted to get him in better shape before
risking the surgery. While fostering
and medicating him at home, I observed no discomfort with the limb, and
continued to delay the surgery.
He
was transferred to another foster home and my decision was questioned by my
fellow rescuers. Opinions differed
whether it was a genetically splayed leg or an injury and what the best
course of treatment would be, although most, if not all, suggested amputation.
Two months after the rescue, a rescuer thought he
was acting a bit lethargic and took him into another vet.
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 which were passed around to the vets and vet techs in the clinic.
One said the bone was compromised, another said the femur is being eaten and
it looked like cancer or infection, another also mentioned osteomyelitis. They all
advised immediate amputation. 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 suggested 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
turns out to be the head of femur + bone regrowth/malunion,
it must be checked if there is pain, if movement is disturbed. If not, the
rabbit can continue this way. If it disturbs movement and/or causes pain, an
orthopedic surgeon should be consulted to discuss different options such as
removing the femoral head, but keeping the femur. Amputation ? Amputation
is really a major surgery, this appeared to be an old injury and this bunny's
leg really didn't seem to be bothering him.
I decided to wait. Several people questioned this decision and I was
pretty much accused of being neglectful, and that the x-rays were showing
infection or even cancer, and that the leg needed to be amputated. I was
always reluctant when it came to broken bones in rabbits, I've seen a lot of
operations using pins and rods go wrong (I've seen just as many neglected
breaks heal on their own), so amputation has been considered the lesser of
the evils. Although I'll still agree
that three-legged rabbits get along just fine and that amputation surgery
isn't a huge risk, I agree that we're also a little too quick to go that
route. 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. If there is no infection, no mass, when the
limb with the broken/malunion/nonunion bone has
remained functional and when the rabbit has adapted and is ambulating well,
without pain, why sacrifice this limb ? Risks when leaving the malunion bone heal ?
On the
long term, pododermatitis, lameness, degenerative
joint disease or arthritis, or ankylosis of a joint
due to slow destruction of cartilage and/or bone, may eventually occur at
some time. Outcome
I asked
my own vet, who had initially recommended amputation, and he agreed the bones
were knitting, but none-the-less again recommended amputation. The rabbit was reluctantly taken in for the
surgery. He was on the table ready to
get the anesthetic when my vet did another examination and found absolutely
no pain responses in the leg. He
decided not to operate. It is two or three months later and the
rabbit is a happy, healthy and active little guy. His leg sticks out to the side and he'll
occasionally bang it on something, but it doesn't bother him. Amputation
is a destructive surgical procedure, and should be considered in a last
resort options only, not as an alternative, even if prognosis is usually good
and rabbits adapt well.
Acknowledgement
A very
heartfelt thanks to MediRabbit (Switzerland) and to Dr Amir Maurer (Companion and Exotic Animal Veterinary Center, Holon, Israel), who took upon
their time to look at the X-rays. Their precious advice helped avoid the
amputation surgery on this rabbit. |
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