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Orthopaedic injuries in rabbits, including fractures and luxations, are a frequent and often challenging presentation in both exotics and small animal veterinary practice. While surgical repair in rabbits can yield highly rewarding outcomes, it is widely acknowledged that the complication rates associated with orthopaedic repair are typically higher than those observed in canine and feline patients. The successful management of these cases is complicated by the rabbit’s delicate skeletal anatomy, challenging bone biomechanics, small patient size and an increased physiological sensitivity to fear and pain.
Optimising patient outcomes requires careful consideration, planning and an integrated approach. An integrated or multidisciplinary approach to orthopaedic injuries in rabbits begins at initial presentation and continues beyond the immediate post-operative period.
It involves patient care throughout all aspects and stages of the treatment journey and includes medical stabilisation, diagnostic imaging, individually tailored analgesic and anaesthetic plans, orthopaedic surgery and an individualised post-operative rehabilitation and physiotherapy program. This case report details the multidisciplinary management of a juvenile rabbit that presented with severe bilateral tibial fractures, highlighting the collaborative effort required to achieve a successful outcome despite significant complications.
Case Presentation
Petal, a three-month-old, female entire mini lop rabbit, was presented to an after-hours veterinary emergency service following an accidental crushing injury in a door a day earlier. The owner was seeking a third opinion after only euthanasia had been recommended.
Upon initial examination, Petal was non-ambulatory, exhibiting Grade 5/5 non-weight bearing lameness in both hindlimbs. Palpation of the distal tibial region revealed significant crepitus and instability bilaterally. Deep pain was confirmed to be present in both limbs. Despite the severity of the injuries and the guarded prognosis, the owner was deeply committed to a treatment plan that ideally resulted in return to function—but was also open to both curative or salvage options. Immediate stabilisation and diagnostic workup were prioritised.
The patient was treated with opioid analgesia and sedated for diagnostic imaging. Radiographs confirmed several traumatic injuries:
• Right Hindlimb: A highly comminuted, markedly displaced diaphyseal fracture of the tibia, complicated by a longitudinal fissure in the distal fragment.
• Left Hindlimb: A mildly comminuted, markedly displaced short oblique diaphyseal fracture of the tibia.
• Pelvis: A mild-to-moderately displaced fracture or subluxation of the right ischium.
Palpation and manipulation of the limbs under sedation revealed moderate contracture of the major right hindlimb muscle groups (quadriceps, hamstrings, and gastrocnemius), which complicated limb distraction efforts. Robert Jones Bandages (RJB) were applied to both hindlimbs for temporary stabilisation. Due to the bilateral, comminuted nature of the injuries, conservative management was not a viable treatment option, leaving surgical repair or euthanasia as the only remaining choices.
Management
Following extensive discussion with the owner regarding the high anticipated peri-operative surgical and anaesthetic complication rates, the owner elected to proceed with surgical repair. A significant pre-operative finding was the patient’s moderate anaemia (PCV of 21%). To mitigate catastrophic consequences of further haemorrhage intraoperatively and to avoid major hypotension, a blood transfusion was initiated prior to anaesthetic induction, running at a rate of 2 ml/hour. The patient was premedicated with fentanyl 0.01mg/kg, midazolam 0.25mg/kg, and glycopyrrolate 0.01mg/kg administered intramuscularly. Anaesthesia was induced intravenously using ketamine 5mg/kg and alfaxalone slow IV (approximately 1mg/kg) to effect. Endotracheal intubation was performed endoscopically, and gaseous anaesthesia was maintained with sevoflurane.
The specialist surgical team worked efficiently to minimise anaesthetic time by assigning one surgeon to each limb to operate concurrently.
The ischial fracture was left to heal by second intention. Both tibial fractures were repaired using locking bone plates secured with 1.3mm locking screws. For the left tibial defect, a large, free bone fragment was crushed with rongeurs and applied as a cortical bone graft to facilitate healing.
Postoperative care
The patient was continued on a fentanyl CRI for the first 12 hours post-operatively. Other immediate postoperative analgesia included oral meloxicam and tramadol, both of which were to be continued for two weeks before review. A one-week course of trimethoprim sulfamethoxazole was prescribed orally.
Petal was restricted to strict cage rest for two weeks, paired with an intensive passive range of motion (PROM) exercise program, performed at 8−12 repetitions three times daily, designed to counter muscle contracture. This was developed by a sports medicine specialist veterinarian and commenced the day after surgery.
Despite careful planning and client adherence to postoperative instructions, complications arose. Twelve days post-surgery, Petal re-presented with acute right hindlimb lameness and paresis. Radiographs revealed implant failure characterised by bone plate migration and a highly comminuted re-fracture of the right distal tibia.
Given the high likelihood of failure with repeat internal fixation, the fracture was managed conservatively to heal by callus formation as a malunion.
Unfortunately, two weeks later, the right tibia remained unstable, lacked deep pain perception, and exhibited cutaneous exposure of the bone plate, necessitating amputation of the right hindlimb, which was performed via coxofemoral disarticulation.
At the time of amputation, the left tibial fracture was confirmed to have healed, although reduced neuromuscular function was noted. Following the amputation surgery, Petal was discharged with a multimodal analgesic regimen of meloxicam and transmucosal buprenorphine, along with another course of trimethoprim sulfamethoxazole antibiotics. Physiotherapy exercises were focused on improving strength and neuromuscular function in the remaining left hindlimb to facilitate adaptation to tripod locomotion.
Outcome
At the two-week post-amputation re-check, the surgical site was fully healed and there was a significant improvement in the neuromuscular function of the left hindlimb, resulting in pain-free, adapted locomotion.
At an 18-month follow-up, the patient was reported to be thriving, showing no signs of pain or complications related to her previous orthopaedic challenges.
This case illustrates that while rabbits are susceptible to orthopaedic complications, a comprehensive, dedicated multidisciplinary approach, and when necessary, salvage procedures like amputation, can lead to an excellent long-term quality of life.
Dr Olivia Clarke BSc BVMS MANZCVS (Unusual Pets, Avian), Avian and exotics veterinarian, Veterinary content creator, Pet Circle
Dr Olivia Clarke graduated from Murdoch University in 2015 with an aspiration to work with birds and exotics. She subsequently had jobs in various specialist veterinary hospitals across Sydney, providing services for birds, exotic pets and wildlife.
Dr Clarke holds membership qualifications with the Australian and New Zealand College of Veterinary Scientists in both Avian Medicine and Surgery, and Unusual Pet Medicine and Surgery, and is an examiner for the Unusual Pets chapter.
Dr Clarke currently works for Pet Circle providing educational content across a number of platforms and telehealth services. She also creates online courses, delivers webinars, presents at conferences and locums on weekends.
