Pet Bravery Awards 2014 - Jessica Rabbits injures her back leg
Jessica rabbit was referred to us by her own vets for a fracture repair. After assessing her during her initial consultation, our surgeon Paul Freeman admitted for her surgery. A long recovery followed as her injury already involved a serious fracture with the additional complication of superficial skin wounds. Successful recovery would be made more difficult by the fact that she had injured her hindleg rather than foreleg Here is her story.
When Jessica was admitted for treatment she had an intravenous catheter placed in the vein on her ear and was started on intravenous fluids, pain-relief, syringe feeding and general supportive care including monitoring of her bowl movements. It was vital that Jessica's digestive tract was normal as digestive upsets in rabbits can be life threatening. With leg injuries in general patients find passing urine and faeces difficult as they are in pain and unable / reluctant to get into their normal position. The knock on effect on the digestive and urinary system needs to be avoided and Jessica's case was not exception. All of this formed the nursing care plan which was drawn up specifically for her when she was admitted.
Jessica's owner commented, "She is a really special bunny. I adopted her from a rabbit rescue centre, where she had been overlooked many times because of her red eyes. I thought that was such a shame as she was clearly an affectionate and characterful rabbit on first meeting. I was looking for a mate for my boy bunny, Balfour and she seemed to like him and he her, so that's how we chose her. She waited nearly a year in the centre to find a home.
She was living in my big bunny shed in the garden, with Balfour when she had the accident. They both liked to jump up on top of a cage in the shed to sit on it. I presume she must have fallen, or jumped down and landed awkwardly, because when I found her, her back leg was clearly badly broken as she could not move and her foot was hanging limp at an odd angle."
It was decided to operate on Jessica the following day to allow her supportive care to take effect and prepare her for the difficult surgery that lay ahead. Jessica's referring vet had already taken radiographs so on the morning of surgery she was ready to be anaesthetised, prepared for surgery and taken into the operating room. She was pre-oxygenated before her general anaesthetic was given, this is something we do with our small animal patients and also elderly patients. In rabbits this is to prepare them for intubation. Intubation is important in rabbits to ensure a patent, secure and safe airway.
Jessica had suffered a transverse fracture of the lower part of her right hind tibia bone, as a result of her fall. Successful repair was important to her well-being. Amputation would be the last resort given that rabbits' hindlegs are integral to their normal movement of running and jumping. Rabbits can adapt quickly if a foreleg needs to be amputated, recover from a hindleg amputation can be more difficult. But with the proposed surgery, post-operative care and restrict rest it was hoped this would not be the case.
During the surgery Paul stabilised Jessica's fracture with pins and a specifically designed dynamic compression plate and screws. He prescribed antibiotics, pain relief and anti-emetic medication and advised strict cage / hutch rest. Post-operative radiographs would need to be repeated 6-8 weeks later when her fracture would be healed, but for this to be brought forward should there be any concerns. Cage rest would not stop Jessica from using her leg, but restrict her use of it, especially important in the recovery of a hindlimb fracture.
Further attention had to be paid to Jessica's wounds on her leg which, without proper ongoing treatment could cause an infection to develop, putting the fracture fixation at risk. The day after surgery her leg was very swollen and a discharge was developing from these wounds. These were bathed in a sterile manner and dressed. Dressing changes, cold compressions and physiotherapy massage over the next few days were added into her individual nursing care plan. Her wounds continued to concern us and under the supervision of RVN Laura Baster, who specialises in complicated wound care, her wounds started to show signs of recovery.
Paul examined her fracture site and reassessed her each day. He was satisfied that there was no palpable crepitus which would indicate that the fracture was not as stable. The fracture repair was holding currently but as there must have been a lot of pressure on it, given it was Jessica's hindlimb, he lengthened her stay in the ward to enforce her cage rest and allow daily examination and continuation of the wound management.
Over the next few days her wounds started to show signs of healing, but Paul had new concerns that some crepitus had developed. She was sedated and re-radiographed and his suspicions were confirmed - the fracture had become unstable. After discussions with Jessica's owner it was decided to take her back to the operating theatre, remove her implants including the plate and replace with a series of new pins and wires, to strengthen and support the fracture site. This would take the form of an external fixation.
Jessica was on the road to recovery and 9 days after she was first admitted she was discharged. She coped very well with enforcing Jessica's cage resting and returned at regular intervals to have her skin wounds examined, treated and dressed. Paul took further radiographs a few weeks later, which showed good healing and remodeling of the bone at the fracture site. All her implants were removed and she was able to use her leg normally, including extending her stifle fully.
Reflecting on Jessica's progress, her owner also commented: "All my rabbits have pet insurance and are registered with a specialist rabbit vet. After she was seen by my own vet, William Lewis, he referred her to Paul Freeman at your practice for the surgery to pin her leg. I would really like to mention Paul to thank him for his skill in performing the two operations. I would most especially like to mention Lindsey Raven-Emerich, who spent so much time with Jessica, nursing her back to health. She is a real bunny expert!
I am absolutely delighted to report that Jessica is 100% recovered now. When I saw that her leg was so badly damaged, I thought that she might well have lost the leg; at one point I came very close to having to make a decision to amputate. I know bunnies can cope with only three legs, but Jessica is such a big bun, and I love to watch her 'binky' round the garden, racing at top speed and then suddenly leaping and springing. For her not to have been able to do this again would have been so sad.
Since the accident, she and Balfour have come indoors to be house-rabbits. She is perfectly house-trained, and likes to spend most of her day lazing around on or under the armchair in my study. I started giving her grapes when she was in the vet hospital and not eating well. Now, she loves them and will stand on her back feet and scrabble at my legs to get me to give her a grape treat every day. She comes into the living room every evening, has a mad binky round and then jumps up on the sofa and pesters me to fuss and stroke her when I am watching the tv! She is a big bunny with an even bigger personality."
Jessica made an excellent recovery and was a patient with a lot of patience! She is now back under the care of her referring vet. But fully deserves her 2014 Pet Bravery Award!