Fractured Pelvis- Advice requested (R.I.P)

[jewelwillow]

HI Everyone.
I'm Beth from Sydney Australia, a new member on the forum. My bunny is injured, and I'm not fully satisfied with treatment of her injury. I'd appreciate any insights you may have had into similar injuries or experiences.

My bunny is Grace and she's a mini cashmere lop, 5.5 years old.
She started favouring her left back leg about 2 months ago, but was still using it without putting her full weight onto it. About 2 weeks later, she wasn't using it at all and I took her to the vet, who said she may have a spinal injury which could get better or could get worse, but couldn't find anything obviously wrong. We have no idea how she could have injured herself, as she has her own enclosed room in a balcony area.

Approximately 2 weeks after that, she started getting progressively worse, but was still hopping on 3 legs. I took her to a different vet, who x rayed her and she has a fractured pelvis. It is broken completely through the bone at the top of the hip socket. Apparently an equivalent trauma to a cat hit by a car. We cannot fathom how it could have happened. When I got her home, she was only using her front 2 legs to move herself around, and I wondered if the vet had injured her more during taking the x ray, as she no longer used her good back leg. He didn't give her any pain medication. He recommended 6 weeks cage rest to restrict movement.

After a week of cage rest, she started hopping around on 3 legs again (Yay!) - for 2 days only. The next day she couldn't get up or move. She had been lying on her side with her good leg was on the bottom, and the 2 front legs are now twisted to one side.

I rushed her to the vet (a different vet in the same practice as the 2nd one). He couldn't find any injuries in the other 3legs to explain the odd position, but suggested physio, and manipulating the other 3 legs to get them moving normally. He also gave her pain medication (finally!)

It has now been a week since I've started physio on her, and she is still badly twisted along the spine, and I'm really worried about her healing wrong. If she sits in the position she's comfortable in, she can't get up or move, and seems to stiffen her muscles and joints into this position. If I correct her "good" leg for her , so it's in the correct positionto hopshe can move and is happy to be able to get around, but the front legs still jut out to her right. Her spine is obviously not in its correct position, but she can't move if I put her in her anatomically correct spinal position, or if I leave her in her resting position.

Any suggestions of how she could have gone from normal shaped rabbit to twisty spine rabbit? There is no spinal injury- as she can still get around when I help put her good leg into the right position to hop, and the front legs still function- just 45 degrees right of normal.

She is still eating normally, though not drinking much, and other bodily functions fairly normal.

Please help if you have any experience, opinions, or advice. Thanks, Beth.

 

[tonyshuman]

This is a pretty rare thing. My initial thoughts are a calcium metabolism disorder like osteoperosis. This would mean that her body is taking calcium out of the bone, weakening it to cause fractures and possibly the spinal twisting. I have also heard of spinal arthritis causing deformity and difficulty moving. Several people here have bunnies with this condition.

I hope you can get some good advice on here. Good luck with her.

 

[dquesnel]

Hi Beth, I am really glad you have posted on here since it seems the first two of your vet visits did not help Grace at all. I cannot believe the first vet did not give you pain meds for her- how would he feel having a broken pelvis??? That is absurd! I want to whack him! ullhair:

That aside, I am trying to visualize how Grace looks but it is tough. Is there any way you can post a photo or video that shows her movement/position?

It is quite common in an injury that impacts the gait of a rabbit to also cause other problems in parts of the body. It sounds as if her spine may have taken some stress from hopping on two legs- especially if it were in an unnatural position. I hate to think it but because she seemed to be improving, and was back on three legs then all of a sudden went to a twisted position... It sounds like spinal cord weakness to some degree. It could be that there is some weakness as a result of the strain, when she is in the correct position she is moving normally you say. It could be that she is having a hard time positioning herself.

I would try to get her to drink as much as possible, by adding another bowl of water with flavor into her room. The hydration will help lubricate the joints and ease any discomfort she may be having.

I would really like to see what she looks like, I think it would be helpful. Also other people on here may have experience with something similar to this so hopefully they chime in. I'm really sorry this happened and that you had a tough time with the vets. I hope it is a matter of physio and correcting her gait etc.

 

[tonyshuman]

dquesnel has a good point that favoring one leg may have caused the injury in the other and the pelvis. A common cause of hind leg immobility is actually a parasite infection called e cuniculi. We have a really good library article on this. It can show up first as hind leg weakness.

 

[jewelwillow]

I have a picture of her position, could someone please let me know how to insert a picture from file- this will only let me enter a picture with URL. Thanks.

 

[Maureen Las]

A fractured pelvis is way out of my field of knowledge, however, it does seem natural that a fracture in that areawould cause a totalshift inthe spinal cord and groups of muscle and bone in an attempt for her body to adapt to the pain and the inability to use her leg.

I started looking on rabbit references and found this story. it is not the same problem ( but similar enough)and was rectified finally by surgery performed by some of the countries most outstanding rabbit vets
I am wondering if surgery is an option at all for your rabbit.? I really have no idea but it is a thought.


http://homepage.mac.com/mattocks/morfz/dislocated.html

 

[Maureen Las]

can you use photobucket?

http://www.rabbitsonline.net/view_topic.php?id=25443&forum_id=66

 

[jewelwillow]

Here's my little Grace. Her front legs are tucked off to the right. The foot you can see at the back is her good right leg, tucked underneath her body and out the side underneath her injured leg. The injured left leg is in it's normal position with the foot parallel to the ground. When I put her "good" leg into position it twists towards the left a bit, and sits along the midline of her body.

 

[Maureen Las]

OMG She is sweet!!!!!!
Poor baby Grace

She is really out of alignment .

I am really unable to interpret her position as I am not a vet let alone an orthopedist but you will get more responses tomorrow and we will try our best to help you help her.
I actually thought that she would look in worse condition.
Maureen

 

[Maureen Las]

Jewelwillow
if you could add your location to your profile it might helpus find some help for her.
Maureen

 

[Maureen Las]

I saw from your first post that you are in Sydney Australia
wondering if the university there could help her??

http://www.vetsci.usyd.edu.au/veterinary_services/sydney/referrals/surgery.shtml

 

[ra7751]

Progessive paresis in left rear leg + spinal twist + possible skeletal issue in pelvis or leg= active E Cuniculi infection. Is she wet with urine? Are the x-rays digital? If so, please send them to me.

E Cuniculi is a common protozoan infection found in rabbits. The original presentation is usually a very mild paresis in the left rear leg and some degree of urinary incontenance. The problem with the left rear leg might just be a very slight stumble every now and then....they may appear to stretch the leg or it might appear that they forget how to use that leg and it's usually for a very brief amount of time. The immune system will mount a response and the condition may appear to resolve. But EC will overwhelm the immune system and the protozoa will start to reproduce in the brain. This usually means the rabbit's neuro response in the left rear leg will deterorate rapidly. Some rabbits may spin since the feet (along with the ears) are used for proper bodyposisitonal orientation. The spinning can result in fractures to the pelvis or hind legs and cause spinal issues. As the spores shed, they are sent thru the renal system. It might appear to bea urinary tract infection and an inexperienced vet will misdiagnose this condition. This will also result in a splaying of the front legs as the rabbit struggles to remain upright. Eventually the entire hind quarter will become useless and atrophy will set in. EC will devastate the immune system and will allow numerous and roving bacterial infections.

EC is particularly difficult to treat. Most likely the neurological damage can't be resolved but aggressive treatment may contain and/or stop additional issues. The problem with treating this issue is getting an appropriate drug to penetrate the blood/brain barrier. The most common treatment involves using a horse wormer known as Fenbendazole (Panacur) every day for at least 28 days....I have run as long as 60 days. I have more recently began treating EC with a drug intended to treat Equine Protozoal Myeloencephalitits (EPM) in horses....which is a related protozoan. This drug easily passes the blood/brain barrier in a horse....and a horse and a rabbit are very similar and medically are treated identically. This is a very expensive drug. I don't know if it's available outside the US. I have a full protocol of medical treatments and husbandry modifications to deal with active EC infections.

The only definite diagnosis for EC is post mortem. I diagnose (I am not a vet) by clinical presentations along with a CBC with EC titer looking for levels of antibodies to EC. Very few vets have actually seen a true and full blown case of EC. This disease will affect every part of the body. The spores that are shed by the protozoa will severely damage the kidneys. Every rabbit we have lost to EC has been to acute renal failure. Aggressive hydration support will slow this damage.

The key for me in knowing this is EC is that your rabbit has a progressive issue. If the primary issue were the fracture, the lameness would have been immediate with gradual reduction in pain. I think the possible fracture is secondary to the paresis issues presented due to EC.

Randy

 

[Maureen Las]

Do you remember anything different about the use of her left rear leg before all of this happened or any wetting of herself or having a wet bottom. ? Claire (Tonyshuman) mentioned this initially......
Randy is suggesting that the protozoan infection ecuniculi was thecause of everything that has occurred..once the pelvis broke everyone concentrated on the break and not the pre-existing condition

I will give you some links to read on e-cuniculi so that you will know what we are talking about



http://www.rabbitsonline.net/view_topic.php?id=14471&forum_id=10
take a look at them

She really does need a rabbit saavy vet to sort this out , however if you do have digital x-rays you could send them to Randy .

 

[tonyshuman]

She really is adorable. I also think your best bet for a vet is the university. I didn't know that EC could progress to the spine and hips, which really makes a lot of sense now. I would still be a bit concerned about her bone density as weakened bones could lead to a fracture without any warning. Looking at x-rays might help to determine if there's a bone density issue or if EC is the primary cause.
Good luck!

 

[jewelwillow]

Grace didn't have any issues with wetness or stumbling, she just started lifting that leg when she ran, though would use it as a balance guide or to scratch with.

It disn't get progressively worse, just one day it was significantly worse all of a sudden. It took it as being a partial fracture that had completely snapped at one pointdue to her still using it.

I don't have a copy of the x rays, but the vet said the rest of her bones were fine, but there looked to be a slight weakness in the bone in the exact same position on the other side of the pelvis. I was looking at the xrays at the same time, and I trained as a nurse years and years ago so I have some idea of medical talk. My observations of the xray agreed with what he said.

The spinal twist appeared suddenly after 2 days of normal behaviour (hopping on 3 legs again).

 

[DeniseJP]

Wow - prayers and healing to Grace - I would love to know what more you find out about her condition.

Denise

 

[ra7751]

I still think we have more going on here than a fracture but that really needs to be addressed immediately. I am assuming it's the femur that is fractured. What type of fracture is it? I would most likely get that leg splinted and administer NSAIDs and most likely a narcotic aspect. I would probably run a CBC just to look at values. Could possibly be a genetic issue or some type of metabolic problem. But regardless, that fracture needs to be addressed properly to prevent spinal issues. I have an amputee here and it is difficult to support his spine and he is also beginning to twist. Something that puzzles me is that the spine is much more delicate than the femur and usually if you get a torque type fracture, the spine is more involved than the femur. Is is possible that she may have accidentally been stepped on or something could have fallen on her? The amputee I have here fractured his rear leg when his owner at that time placed a towel with holes in it inside his cage and he got caught. I am amazed he didn't suffer a spinal.

 

[jewelwillow]

The fracture is in the pelvis, above where the hip sits in its ball and socket joint- at the top of the socket.

 

[Maureen Las]

Can you talk with your current vet about some of the topics that we have brought up here and/ or begin to seek out a sophisticated vet clinic that can handle more than 'run of the mill" rabbit problems.

 

[dquesnel]

Hi Beth, I have been thinking about her and am wondering how Grace is doing?

From your description it sounds like trauma occurred to Grace that is impacting her ability to move and position properly. It is interesting that there was also a weakness visible in her xray on her other side. Often one side of the body may have a fracture, but two is unusual so I wonder if she fell while trying to hop on something etc.

From everything I know of an injury to this kind of place on a mammal's body, pain meds and rest are probably the best thing. I know you are concerned about her healing wrong, and what can be done to prevent that. If you don't have much luck with the university, I wonder if someone may be able to do a phone consult with this vet: http://www.exoticanimalcare.com/services.html#vet

I remember reading somewhere that Dr. Kelleher is experienced with a variety of fractures and orthopedics in rabbits. The vet to vet consult is provided free of charge, so I wonder if that is an option at all?