Category: Rabbit

Rabbit Femur Fracture Surgery

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Rabbits have powerful muscles to their hind legs. If they get stuck or trapped in something, they can kick out and cause a bone to break. In many cases a splint or heavy bandage will suffice. Sometimes surgery is needed, as in this case.

Graphic surgery photos to follow. Click on any photo to enlarge.

After a thorough physical exam and stabilization, radiographs were obtained.

This is called a traverse fracture of the distal femur (see arrow below). This is a serious fracture and requires surgery from a surgeon experienced with orthopedic surgery.



Meticulous preparation is necessary in orthopedic surgery. If an infection gets started it tends to become deep seated and hard to control.

The technique of taping the leg up is the standard in how we clip and clean the leg prior to surgery


Anesthetic monitoring is important is such a small animal, and an animal that has such a small lung capacity compared to other animals of comparable size

The heart and lungs (within the red circle) are tiny compared to the size of the abdomen


Due to this unique anatomy constant monitoring is needed during anesthesia


Our anesthetist works closely with our surgeon to make sure just enough anesthetic is given at the lowest possible dose


Our surgeon feels the fracture through the skin to find the best place to make the initial incision. You can see the foot double wrapped in a special towel and also plastic wrap at the lower right of the photo. The foot is not a part of the surgery, and draped this way so there is no contamination.


The initial skin incision exposes the muscle layer below. There is minimal fat under the rabbits skin so this initial skin incision has to be done carefully or else the scalpel will cut into the muscle.


A layer of tissue over the muscle is cut with scissors


Our surgeon carefully dissects through the muscle to get down to the bone


After carefully dissecting through specific muscle planes a special instrument is used to spread the tissue for better access to the fracture


With the bone exposed our surgeon now assess the damage. Even though the radiographs taken before surgery give us substantial information, decisions on how to repair the fracture are only decided at this point. You can see the tip of the fracture at the arrow.


The fracture end from a different angle


A stainless steel intramedullary (IM) pin is placed down the shaft of the bone. This is the first part of stability of the fracture site. You can see the pin entering the open end of the bone on the left.


A special instrument is used to slowly rotate the pin through the shaft of the bone as it is placed completely into the bone


Once the pin is in place a stainless steel bone plate is hand molded to the contour of the femur


A hole is drilled into the bone


A tap less screw is then inserted


This is repeated at the other end of the bone. You can see our surgeon measuring how deep a hole has been drilled into the bone. This helps pick a screw that is just the right length.


The correct size screw is now placed. This is the 2nd aspect of stability of the fracture site


After putting in 3 screws our surgeon decided that more screws might damage the bone. Two cerclage wires are now used, which is the 3rd aspect of stability.


The tissue over the muscle is sutured


Finally, the skin is sutured


Our post operative radiographs show what was done


Can you see all 3 aspects of the stability?


At this point our little friend is take off anesthesia, kept on 100 % oxygen, given a pain injection, kept on a heat blanket, and closely monitored until fully awake.

Before fully awake we use our Companion Laser to stimulate the healing process and decrease post operative swelling at the incision


After surgery our rabbit patients are wrapped in a towel and closely watched by our staff


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Rabbit Skin Infection

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Rabbits are prone to skin infections that can be difficult to control. Their skin is very thin and prone to trauma. Rabbits harbor a bacteria called Pasteurella than can complicate any infection they pick up. This page shows the case of a rabbit named Roger that has a serious skin infection due to a maggot infestation. You won’t have to look at any maggots, but you will see a serious skin infection in the pictures that follow-these pictures are not suitable for all age groups.

Maggots are the larvae of flies that hatch when flies lay eggs on an open wound. In the warmer climates, especially in the summer, we see this condition. It occurs when rabbits soil their fur, sometimes from diarrhea, and set up a moist environment that attracts flies.

A way to prevent diarrhea in rabbits is to feed minimal amounts of rabbit pellets. The majority of their diet should consist of timothy hay and timothy hay pellets. The higher fiber content of these foods keeps their teeth worn down properly and aids in digestion, since they require a diet very high in fiber compared to other pets.

These are the molars of a normal rabbit that has been on a good diet of mostly hay.


You can learn about the problems that rabbits get with an improper diet by following these two links-

G. I. Stasis

Overgrown Teeth

This page contains very graphic photos of a severe skin infection




This rabbit was referred to us from another veterinarian. They initially cleaned up the wound, put the rabbit on oral antibiotics, and put stainless steel staples in the skin to suture the open wound that was present. This is the way we typically handle most wounds. Unfortunately, some rabbits don’t respond to this suturing, especially if it is not done immediately. As a result the wound can fester under the sutures and become a serious infection. Rabbit pus is tenacious and does not easily drain from the body like other mammals. As a result, it is difficult to work on these infections in the normal manner.

You can visualize the Y shaped staples that are holding the skin together at the top. They are not holding at the bottom. The white material at the bottom where the incision is open is the tenacious pus that rabbits get when there is an infection.



We attempted to keep the sutures in place and treat the open wound at the bottom. We thoroughly flushed the wound under the staples and trimmed off diseased tissue. after one week of this therapy the infection got worse so we had to remove all the staples and treat this infection as an open wound.

This is the wound immediately after we removed the staples and removed the dead tissue along with infection. It is impossible to remove all the infection that is present due to the tenacious nature of rabbit pus.

A special wound healing agent containing collagen was used to aid the healing process. It draws infection out of the contaminated area and sets up an environment for healthy tissue to start covering the opening.

The wound is thoroughly covered with this collagen and allowed to stay on for several days initially. It was changed several times over the several weeks of therapy that was used in this case.

It is bandaged to keep it in place and to protect the healing tissue.



This rabbit healed fine, which is not always the case with such a serious wound. From the time he was brought in to us until this picture was taken was 5 weeks.

Here is Roger’s read end on his last recheck. He feels a lot better now that his fanny is not so exposed.

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GI Stasis (hairballs) in Rabbits

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Gastrointestinal (GI) stasis  is a common cause of digestive disease in rabbits (lagomorphs). In most cases at our hospital the cause is a diet that is too low in fiber. You will sometimes read the term “ileus” when talking about this disease. Ileus occurs when the normal intestinal movement of food through the intestines, called peristalsis, stops. Normal digestion is dependent on normal peristalsis of the intestines. Peristalsis is the movement of ingesta down the stomach and intestines. When this stops GI stasis is the result.

Sometimes a hairball (also called wool block) is considered a part of this disease. In reality, over many years of treating rabbits we have learned that any hairball in the stomach is a result of GI stasis and not the cause of it. Ingesting hair is a normal part of a rabbits life, and when fed the proper food this small amount of hair passes through the digestive tract normally.

This page contains graphic pictures of rabbit necropsy pictures. This is a good way to understand the rabbit’s digestive anatomy. It might not be appropriate viewing for all ages.

Digestive Physiology

Herbivorous animals like horses, rabbits, deer, cows, antelopes etc., obtain their nutrition by digesting food that carnivores cannot. A lot of this food is made up of cellulose. Neither carnivores or herbivores contain the enzymes necessary to digest this cellulose. The secret that herbivores have that allows them to digest this usually undigestible food lies in bacteria that reside in their GI tract.

Some herbivores are called foregut fermenters. This means the bacteria that help these animals digest cellulose reside at the beginning of the digestive cycle. Sometimes this occurs in the rumen, one of the so-called 4 stomachs in a cow. These stomachs are actually large fermentation chambers that contain the bacteria that can digest cellulose. Examples of this cellulose are hay and grasses.

In this anaerobic environment, the bacteria consume the plant material for their own metabolic needs and, as a result, produce end-products of fermentation called volatile fatty acids (VFA).  Additionally, the fermenting bacteria use nitrogen from plant material to produce amino acids and protein which can then be used by the animal. Once these bacteria digest this cellulose they produce volatile fatty acids (VFA’s) and amino acids. These nutrients are absorbed as they pass through the small intestines and into the large intestine.

In contrast, hindgut fermenters store these bacteria in the cecum (appendix) and large intestine. In the case of the rabbit, there is a complex interaction between the colon and the cecum(appendix) that gets this bacterial fermentation process started. The VFA’s and amino acids that are now the end product of bacterial metabolism pass into the large intestines and out the body. They do not get a chance to pass through the small intestines because of their location, and as a result, less nutrition is absorbed by the herbivore.

Here is a picture of the cecum taken during a routine necropsy of a rabbit. The top white arrow on the left points to just one of the 4 horizontal folds of this rabbits cecum. As you can see, it is huge and takes up a large amount of the abdominal cavity. For perspective, the arrow on the lower left points to the uterus in this female rabbit, and the arrow on the lower right points to the urinary bladder.

Another view with just a part of the cecum outside of the abdomen. Notice how the cecum has folds.

Here is an x-ray view of the abdomen of a rabbit. This rabbit is laying on its right side, and the head is towards the left. The cecum is that long and horizontal dark object at the bottom. It is dark because it is filled with gas from the digestive process. The white arrow points to it.  Notice also the folds that can be seen radiographically.

Hindgut fermenters have a problem that foregut formenters do not. As we mentioned earlier, since the bacteria are in the cecum they are at the end of the digestive system in the rabbit, and thus there is very little intestines to absorb the volatile fatty acids and amino acids produced by the bacteria before they get excreted by the body. The walls of the cecum can absorb some of the VFA’s that are produced. There is not enough intestine though to absorb the proteins and amino acids.

To get around this rabbits have evolved a sophisticated form of coprography (eating feces). In essence, and usually at night (they are sometimes called night droppings), the rabbit literally puts it mouth by its anus and eats some of its fecal matter. This literally brings the nitrogenous proteins and amino acids to the beginning of the digestive tract where they can get absorbed much more efficiently. Usually these droppings are soft in nature and are not the same firm and dry droppings you normally observe in abundance from your rabbit.

This whole system in the rabbit is designed around a high fiber (cellulose) diet. This is why feeding concentrated rabbit pellets is not healthy, and can lead to a shut down of this whole digestive process. This will lead to GI stasis and the potentialf or serious disease, pain, and even death in a rabbit.


As the intestines slow down food and hair can become stuck, leading to pain and a further slow down of the intestines (called ileus). A hairball can now form in the stomach adding to the problem. Harmful bacteria can now produce in great quantities and cause the intestines to fill with gas. They overwhelm the normal bacteria and can even produce toxins. This intestinal distention with gas causes even more pain and further ileus. It becomes a positive feedback cycle until the rabbit stops eating and becomes weak and dehydrated. It is at this point most people bring their rabbit in for us to give medical care. This whole process can take anywhere from several hours to several days. It can be slow and insidious or acute and quite apparent that something is wrong. In any case you need to seek immediate medical attention for your rabbit.

In the past this disease was erroneously thought to be a hairball problem. It was treated surgically where we literally did a surgery to open up the stomach and remove the hair and ingesta that was present. Unfortunately, most of these rabbits did not do well postoperatively. As time went on and we learned more about this disease it became apparent that the hairballs were a result of the GI stasis problem and not the cause of this. SInce then we have treated this disease medically with much greater success. Success depends on how soon in the disease process we treat your rabbit.


There are numerous causes to this problem:

  1. Dental Disease

    Rabbit teeth continuously grow. If their dental anatomy is imperfect an incisor or molar tooth can overgrow and prevent them  from being able to chew their food. This will cause the GI tract to stop working and lead to stasis. Our Dental Disease link can give you examples of overgrown teeth.

    This rabbit has overgrown incisors preventing normal chewing.

    Dougsie Doughty 7012

    Click here to learn more about rabbit tooth problems

  2. Adhesions from prior abdominal surgery

    Probably the most common abdominal surgery performed on a rabbit is an OVH (commonly known as a spay). On very rare occasions the healing process can cause adhesions between the uterus and GI tract, making the normal peristalsis movements abnormal.

  3. Infection

    A sick rabbit can easily spike a fever causing it to become anorectic (not eating). When food is not continuously present in the rabbit GI tract is shuts down leading to GI stasis.

    Some infections (urinary tract or abscess) can cause pain, which will also lead to anorexia. Pasteurella, a very common rabbit infection, can also has the potential to lead to GI stasis.

    Inappropriate use of antibiotics, especially home use with the wrong antibiotic at the wrong dose, can disrupt normal bacteria (called normal GI flora) and add to this problem.

  4. Pain

    A rabbit that is in pain will become anorectic, which can lead to GI stasis. The pain can be from numerous causes like fractures, bladder stones, infections, and post operatively.

    A fracture like this can be so painful your rabbit will stop eating. This fracture is in the front leg of a rabbit.

  5. Stress

    Overheating in the summer time, food that is not fresh, new pets or environment, or sudden changes in diet can lead to so much stress that your rabbit stops eating. This rapidly leads to dehydration and GI stasis. In a household with more than one rabbit the separation of the rabbits can be stressful.

  6. Intestinal blockage

    This is a rare cause of GI stasis in rabbits. Even though rabbits cannot vomit they don’t tend to eat foreign bodies like bones, needles, threads, and yarn like dogs, cats, and ferrets.

  7. Inadequate fiber in the diet

    This is the cause we see most commonly in our hospital. Your rabbit should be fed grass hay like timothy hay along with dark leafy greens. It should be feed mininal to no concentrated pellets. These pellets were formulated for convenience and for breeding rabbits that needed the concentrated energy. High fiber in the diet helps to properly wear down the rabbits teeth that grow continuously through life.


Symptoms can be subtle and easily missed, especially at the early stages. The two primary symptoms to watch for are complete or partial anorexia (lack of appetite) and a diminished amount of droppings. Sometimes these droppings will be quite dry and firm. Other symptoms could be lethargy and signs of discomfort when you pick up your rabbit or touch it. Bunnies that are painful will grind their teeth. They might start eating strange objects like paper and wood to increase the fiber in their diet.

Please keep in mind that GI stasis can occur simultaneously with other diseases, especially when these other diseases are the cause of the problem. We discussed some of these causes earlier.


This is not a disease you should diagnose at home and then try a home remedy. This is because other diseases can mimic GI stasis, other diseases can be occurring simultaneously, and also because by the time you notice a problem the disease is already well entrenched. The longer you wait for an accurate diagnosis the poorer the prognosis becomes.

Our diagnosis of GI stasis follows the diagnostic process like it does for all our patients. You might want to link to the diagnostic process to learn about it before continuing on GI stasis.

  • Signalment

    GI stasis tends to occur in middle aged and older rabbits of any gender.

  • History

    Rabbits with this problem tend to be feed a diet that does not have enough fiber. There might be a history of prior surgery, trauma, or a stress related episode like boarding your rabbit in a strange environment. Maybe a home medication was used that disrupted the normal bacteria in the intestines  (GI flora).

  • Physical Exam

    Our doctors perform a thorough exam to determine the exact nature of your rabbits problem. This is important since other diseases can mimic GI stasis. We will weigh it and take its temperature as a start. We will check the molar and incisor teeth carefully for any problems. We will check lymph nodes and palpate the abdomen, along with checking the heart with a special stethoscope for small animals. We will also determine your rabbit’s state of hydration.

    When our exam is completed we will give you an assessment of your rabbits condition and review all the potential disease that might be affecting your bunny.

  • Diagnostic Tests

    Routine tests include a blood panel, urinalysis, and fecal exam for parasites. It is also common to take a radiograph to check for other problems and confrim the diagnosis.

    This is the radiograph of the abdomen of a rabbit that is laying on its right side. The arrow is pointing to a round stomach filled with ingesta. This could be normal food or it could be the result of GI stasis. If this rabbit has a history of not eating for several days then it increases the probablity of GI stasis.

    Different rabbit, different view. This rabbit is on its back, with the head at the top, arrow pointing to the stomach. The dark area at the top on each side is the lungs that are in the thorax. Everything below this dark area is in the abdomen.  Notice how large this distended stomach is. This has the potential to be a GI stasis problem just like the radiograph above.

    If one of our doctors suspect more than GI stasis he/she might want further diagnostic testing. This might include special blood titers and ultrasound.


Most cases are treated in our hospital. These rabbits need medication and nursing care, at least initially, that can only be properly performed by our technicians. Some rabbits respond well in 1-2 days and start eating and producing droppings. Others can take 1-2 weeks to get back to normal function. Patience is importance because the rabbit GI tract is sensitive and overzealous treatment can do more harm than good.

  • Fluids

    Many of these rabbits are dehydrated and need fluids. We give them orally, intravenously or subcutaneously.  The fluids replace electrolytes, provide vitamins, and rehydrate your rabbit. Rehydration is important in general for any sick animal, and is especially important in GI stasis to help with normal peristalsis and movement of ingesta through the intestines.

  • Assist Feeding

    The GI tract needs to get back to normal function asap. I lack of food will shut down the GI tract and cause ileus, adding to the GI stasis. As we are rehydrating we will also assist feed special food called Critical Care. This stimulates the peristalsis movement of the intestines and adds badly needed nutrients.

  • Feeding a proper diet

    We give timothy hay along with dark green wet vegetables like Kale. The fiber and moisture present in this food is an aid in getting the intestinal peristalsis going again. Alfalfa hay is not recommended because of excess calcium and protein.

    Other good foods to feed are dandelion, mustard greens, parslely, carrot tops, broccoli, melon, oranges, mango, tomatoes, and kiwi.

  • Medication to stimulate the intestines

    The two primary medications used in rabbits to stimulate the intestines back to normal peristalsis are Cisapride and Reglan. They are highly beneficial and used in most cases.

  • Pain medication

    These rabbits are in significant pain due to the distention of the intestines. This pain needs to be addressed if they are to begin eating again. Typical medications include narcotic pain killers and the NSAID Metacam.

  • Antibiotics

    Antibiotics are sometime used.  If we determine your pet has an infection from its lab data or physical exam we will put it on a broad spectrum antibiotic. Common organisms the proliferates in the cecum in GI stasis are E. Coli and  Clostridium.

  • Anti gas medicine

    If there is more gas in the intestines than is normal we might give simethicone to help diminish it. This gas can make the problem worse and will cause pain.

    Once a rabbit is eating on its own partially and producing droppings we will send it home. We might use some of the medications described above. We will all send home Critical Care food to make sure it is taking in nutrition as it convalesces.

  • Treatments we do not do

    Some treatments have the potential to make the problem worse. Probiotics and yogurt have milk starches and sugar that can feed the Clostridium bacteria. Lactobacillus has not been shown to be of any benefit, and if it is stressful to give this orally to your bunny could actually be detrimental. The same applies when you try to feed your rabbit “night droppings”. The proper word for night droppings is cecotropes. Hairball remedies can also cause a problem. The enzymes in pineapple are unable to dissolve a keratin mass in the stomach, and might even provide the Clostridium with sugar so it can keep on proliferating in the cecum.

  • Home Care

    Once your rabbit is eating and producing droppings in increased frequency, and if the lab data is normal, we will send your bunny home with you to finish the nursing care. Our doctors will tell you what to do and our staff will demonstrate how to administer this home care. We are always here to help you, and if you cannot do it we will continue to hospitalize your bunny or treat it on an out-patient basis.

    If you have other rabbits at home let them interact together as long as you can monitor the eating habits and droppings of the sick one.


Minimizing stress (heat, overcrowding), proper diet (high in timothy and other grass hays, minimal pellets), a clean environment, fresh drinking water at all times, can be a substantial help in minimizing this serious problem. Do not let your rabbit become obese.  Bring your rabbit in for an exam at the earliest sign of any problem with appetite or droppings.

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Rabbit X-Rays

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Broken bone. This is a traverse fracture of the distal femur. It needs surgery



A bone plate along with an IM (intramedullary) pin was placed along with 2 cerclage wires


You can see the surgery of repairing this fractured femur by following this link

This is a side view of a rabbit’s mouth. The long front teeth and large back teeth are evident (arrows).

This is a view of a normal rabbit that is laying on its back. Notice how large the abdomen is in relation to the size of the chest. The larger R and larger L show which side is Right and Left. The two small L’s are the black lung tissue. The heart (H) is the round white object. Everything else below this is the abdomen!

This rabbit has a fractured spine (arrow). This is a relatively common problem in rabbits because they have thin bones in relation to powerful muscles. If they kick out hard with their back legs they can cause this fracture. Unfortunately, the prognosis for this problem is poor.

This is the U shaped distended stomach (arrow) of a rabbit that was diagnosed with hairballs. Compare it to the normal x-ray above. Feeding a diet high in fiber (timothy and alfalfa hay) with minimal pellets helps prevent this problem

A side view of this same rabbit shows the distended stomach (arrow). Again, you can see how large the abdomen is in relation to the chest. The lungs (L) are the dark triangle, the heart (H) is the round white object also in the chest, and the kidneys (K) are the two oval objects in the abdomen. The remainder of the abdomen to the right is made up mostly of the small and large intestines.

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Home Care of the Surgical Patient

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When your pet first returns home from surgery let it have a calm and quiet spot away from other pets and children. It will be groggy from the pain medication it is given, which is exactly where we want it to be.

After it is home and settled, offer a small amount of water. Even though most pets are fasted prior to surgery, at our hospital they are give intravenous fluids or water after surgery, so do not worry if your pet does not drink initially.

If it drinks, and does not vomit, offer small amounts of water periodically over the next several hours, and then offer small amounts of food the same way. Give it a chance to go outside to the bathroom several times.

Use all medication, especially pain medication, as directed. What might seem like pain can sometimes be confusion after the day’s activities and surgery. If your pet seems painful several hours after returning home please call us. It is rare for a pet to be painful after surgery. We take special precautions so that does not happen. Some of these precautions include:

Preanesthetic pain patch and sedation

Local anesthetic at the surgical site

Laser surgery

Post operative pain injection

Post operative pain medication at home

Many pets will go home with an E-Collar (Elizabethan Collar) to prevent them from licking or chewing at the incision site. Leave this collar on at all times until sutures are removed, unless you are in direct supervision. Some people take the collar off after a few days when healing is progressing well and the collar seemingly is not needed. This coincides with the itchy phase of the healing process, and most pets can cause damage to the incision, or worse.


Make sure you put your E-Collar on your pet and not on yourself!

After surgery one of our doctors will call you with a post operative update. You will also be given a detailed post operative handout when you pick up your pet.

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