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



## jewelwillow (Mar 22, 2009)

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.


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## tonyshuman (Mar 22, 2009)

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.


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## dquesnel (Mar 22, 2009)

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.


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## tonyshuman (Mar 22, 2009)

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.


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## jewelwillow (Mar 22, 2009)

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.


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## Maureen Las (Mar 22, 2009)

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


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## Maureen Las (Mar 22, 2009)

can you use photobucket?

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


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## jewelwillow (Mar 22, 2009)

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.


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## Maureen Las (Mar 22, 2009)

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


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## Maureen Las (Mar 22, 2009)

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


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## Maureen Las (Mar 22, 2009)

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


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## ra7751 (Mar 22, 2009)

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


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## Maureen Las (Mar 22, 2009)

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 .


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## tonyshuman (Mar 22, 2009)

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!


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## jewelwillow (Mar 22, 2009)

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).


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## DeniseJP (Mar 22, 2009)

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

Denise


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## ra7751 (Mar 22, 2009)

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.


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## jewelwillow (Mar 22, 2009)

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


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## Maureen Las (Mar 23, 2009)

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.


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## dquesnel (Mar 25, 2009)

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?


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## jewelwillow (Mar 25, 2009)

HI Everyone, Thank you for your feedback about Grace. Here's an update. I had planned to take her to a new vet this week, as I've had someone refer a vet to me who deals more with small animals, and who isn't too far away, but today she was using one of her front arms more than she has over the past few weeks, so I'll see how she goes with that. I've been letting her rest in her comfy position, and only propping her up when she tries to get up herself, rather than periodically throughout the day, so I'll see how she goes with the extra rest. I figure I'll give her another week, now that there is a slight change in her movements. I really don't think it's E Cuniculi as her symptoms aren't fully the same, although there are similarities. When I next visit the vet, I'll run it by them just as a precaution anyway. If there are no further improvements this week, I'll head to the new vet. If she improves, we'll go back to the old vet for an update and reappraisal, maybe a new xray to see if she's healing properly, and maybe suggest a phone consultaion with Dr. Kelleher, as suggested by dquesnel.
She has also been more interested in her regular food, not just treats over the last day or two, so I'm hoping that is also a sign of improvement.

I really appreciate your thoughts ans prayers, and the time you've taken to write and help my little Grace. I'll keep updating as anything else happens.
Beth.


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## jewelwillow (Apr 1, 2009)

Update on Grace: Grace hasn't shown any improvement over the past week. We went to a new vet today, (who has more rabbit experience) who says she has bone spurs along her spine, which is restricting her proprioceptive reactions, and affecting where she thinks her legs are, and thats why she's twisted. It's his opinion that this inability to know where she was putting her feet accurately is likely to have caused the fracture initially. This is also the reason her front legs have twisted. It's just that the fracture was the most obvious feature of the x ray, that the previous vet just treated that without realising there was another underlying problem. Unfortunately, there's no cure for her condition. For now, she's having higher doses of pain medication. If all goes well, it will reduce inflammation in her spine, and show an improvement in her front legs. If this is the case, it's medication for the rest of her life. If she doesn't improve, we will have to reassess whether her quality of life will be worthwhile if she remains twisted. Any improvement should happen over the next few days, so keep your fingers crossed for her. We have another appointment next wednesday to have another xray of the full length of her spine to see how bad the spurs are, and follow up on the results of the medication dosage increase. Please keep her in your thoughts and prayers, I'm hoping against hope that she shows an improvement.


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## anneq (Apr 1, 2009)

Keeping you both in our prayers, Beth.


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## Maureen Las (Apr 1, 2009)

Poor Grace

I hope the medication helps her get more mobility


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## tonyshuman (Apr 1, 2009)

Poor girlie and poor you. I'm glad this vet was able to give you a good diagnosis. It makes sense to me and sounds like this vet knows what he's talking about. It's too bad that the prognosis isn't so good. I hope the pain meds can give her some movement. If they don't, and you still think her quality of life is good, there are a lot of things you can do to make it easier on a bunny with mobility issues, like special bedding to wick urine away, even infant diapers! It may in the end be more humane to put her to sleep, but I know you'll make the best decision for your girl. ray:


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## jewelwillow (Apr 4, 2009)

Update on Grace: She has gotten a lot worse since the last vet visit. The vet put her metacam dosage from that of the 2kg (shes 2.1kg) to a 5kg dosage. She sits there as if she's stoned out of her brain, and hasn't really wanted to move, eat or drink since. She's also been breathing heavier since the visit. I called the vet who says being spaced out isn't due to the medication. The metacam pack information says lethargy and lack of appetite can be side effects of metacam though. She ate a tiny bit of her pellets yesterday and some celery leaves,and I managed to syringe in a couple of ml of water but today she won't touch anything, I've tried all her favourites, and she won't eat a thing. I blended up some celery and carrots to syringe feed her, and she just lets it dribble out of her mouth. I think I might have to put her down, as there's not any "Grace" personality showing anymore. She just looks through me- doesn't even seem to realise I'm there, and she's always known who her mum is. I've never had to do this before with any of my pets, and I don't know what to expect. I'm utterly devastated. My next vet appointment isn't til wednesday, and I can't watch her like this for another 4 days, but I also don't know how I can get out of work to take her in ( I run my own business and have jobs booked in that can't be rescheduled). I don't like any of the vets I've been to, and I hate to get someone I don't like to do it. Can anyone help with some info or insights as to what they would do? Thanks, Beth.


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## Maureen Las (Apr 4, 2009)

Are you and your vet available today?

If so I would call , talk with him and bring her in 

it sounds like shedoes have not any quality of life anymore. Does not want to eat, is not active, is not fighting to live 
if she was my bun I would have her PTS 

she is your bun and you need to go with your feelings and her feeling but it doesn't sound as if she hasfight anymore 
Listen to what she wants you to do ................

Poor little Grace 

ray:"Hugs" 

Maureen


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## jewelwillow (Apr 4, 2009)

Gracie died about an hour or so after my last post. Although I know it was best for her, I'm heartbroken. Thank you guys for all your support!
Beth.


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## SweetSassy (Apr 4, 2009)

ray:


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## Maureen Las (Apr 4, 2009)

Oh I am so sorry for your loss of her. it is truly sad but you did everything that you could......:cry1:
:bigtears::angelandbunny:

You were a great mom to her.....


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## dquesnel (Apr 4, 2009)

Beth I'm so sorry, you did your best. Thank you for keeping us updated, I wish it didn't end like this.
:bunnyangel2:


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## Leaf (Apr 4, 2009)

((hugs)) I'm so sorry.


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## DeniseJP (Apr 4, 2009)

:hug::angelandbunny:

Sorry to hear about Grace - 

Denise


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## JimD (Apr 4, 2009)

i'm so sorry 

binky free little one

ray::rainbow:


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## anneq (Apr 5, 2009)

Beth, so sorry to hear about your sweet bun...you were a great friend and mom to her when she needed that the most.

/hugs
Anne


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## tonyshuman (Apr 6, 2009)

I'm so sorry you lost her. You did the very best you could for her, and I know she was very grateful for your devoted care. Big hugs to you in this difficult time. I'm sorry the vet couldn't do anything to help her, but you really did everything you could.


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