Iranian Journal of Veterinary Medicine Original Article

10.22059/IJVM.2022.336985.1005225 Volume 16- Issue 4

Online ISSN: 2252-0554

Characteristics of Fractures of the Appendicular and Axial Skeletons in Rabbits

and Hares: A Retrospective Study
Rodrigues, C.S.M.P.1, Rahal, S.C.1* , Silva Júnior, J.I.S.1, Silva, J.P.1, Mamprim. M.J.1,
Figueroa, J.G.1, Tokashiki. E.Y.1, Melchert, A.2
1. Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal Science, São Paulo State University
(UNESP), Botucatu - São Paulo, Brazil
2. Department of Veterinary Clinics, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu - São
Paulo, Brazil

Abstract
BACKGROUND: The frequency and characteristics of fractures may vary according to the environment.
OBJECTIVES: The present study aimed to assess the fractures of the appendicular and axial skeletons in rabbits
(Oryctolagus cuniculus) and hares (Lepus sp.) presented at a veterinary teaching hospital.
METHODS: Medical records and radiographs were retrospectively analyzed over eight years.
RESULTS: Twenty-six pet rabbits and five free-ranging hares were enrolled in this study. Twenty-one of them had
fractures in the appendicular skeleton, nine in the axial skeleton, and one in both. The fractures were related to
traumatic events, such as being hit by a vehicle (22.58%), falling (12.9%), being attacked by another animal
(12.9%), and having a paw stuck in a hole (3.22%); 48.38% had an unknown cause. Long bone fractures were found
in the humerus (n=2), radius/ulna (n=1), femur (n=5), and tibia (n=12). Fractures involving the distal aspects of the
limbs included the tarsus (n=1) and metatarsus (n=2) bones. Except for one rabbit, all of the others had unilateral
fractures. Fourteen presented closed fractures, and nine were open fractures. All these fractures were complete,
56.52%% simple, and 43.47% multifragmental. The procedures used included osteosynthesis (42.85%), external
coaptation (28.57%), amputation (14.28%), euthanasia (4.76%), and two animals died (9.52%). The fractures of the
axial skeleton included the vertebral column (n=6), mandible (n=3), and pelvis (n=2). Five fractures were treated
conservatively, and the rabbits were euthanized in four cases.
CONCLUSIONS: The fractures resulted from a traumatic episode, which had an unknown origin in most of the
cases, involving mainly the appendicular skeleton, being the tibia the bone most affected.
KEYWORDS: Bone, Lagomorphs, Radiography, Trauma

Correspondence
Sheila Canevese Rahal, Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine
and Animal Science, São Paulo State University (UNESP), Botucatu - São Paulo, Brazil. Tel: +55 (14) 38802041,
Email: [email protected]
Received: 2022-03-08
Accepted: 2022-06-13
Copyright © 2022. This is an open-access article distributed under the terms of the Creative Commons Attribution- 4.0 International License which permits Share, copy
and redistribution of the material in any medium or format or adapt, remix, transform, and build upon the material for any purpose, even commercially.

How to Cite This Article

Rodrigues, C.S.M.P., Rahal, S.C., Silva Júnior, J.I.S., Silva, J.P, et al. (2022). Characteristics of Fractures of the Appendicular
and Axial Skeletons in Rabbits and Hares: A Retrospective Study. Iranian Journal of Veterinary Medicine, 16(4), 338-347.
Rodrigues, C.S.M.P et al. Iranian Journal of Veterinary Medicine

Introduction
Rabbits and hares belong to the Leporidae family, carnivores (Meredith, 2016), the stress and pain re-
order Lagomorpha; however, the term hare is re- actions are different from those in dogs and cats
served for Lepus genera (Graham, 2015). Rabbits are (Hillyer, 1994; Miwa and Carrasco, 2011; Guzman
a popular pet for adults and children in a substantial and Kapatkin, 2021).
number of countries throughout the world (Hillyer,
Since the frequency and characteristics of frac-
1994; Miwa and Carrasco, 2011). Pet rabbits' life ex-
tures may vary according to the environment, this
pectancy is more than seven years, reaching 11-12
study aimed to retrospectively assess fractures of the
years or longer (Hillyer, 1994; Harcourt-Brown,
appendicular and axial skeletons in rabbits
2002; Meredith, 2016). On the other hand, wild rab-
(Oryctolagus cuniculus) and hares (Lepus sp.) pre-
bits may not survive beyond their first year
sented at a veterinary teaching hospital.
(Meredith, 2016). The small breeds of rabbits are
sexually mature at approximately 4-5 months, and
larger breeds at 5-8 months of age (Harcourt-Brown,
2002). Materials and Methods
The skeleton is equivalent to 7% to 8% of the This study was approved by the Institutional Eth-
body mass and is considered somewhat fragile in ics Committee on Animal Use (CEUA: 074/2020).
rabbits (Cruise and Brewer, 1994; Brewer, 2006; Medical records and complementary diagnostic ex-
Miwa and Carrasco, 2011). The bones are brittle, ams (based on radiographs) of rabbits and hares with
with thin cortices (ratio of the thickness cortex/bone fractures, evaluated at the Center for Medicine and
of 12%), and have lower density and higher mineral Research in Wild Animals (CEMPAS) from a veter-
composition than dog bones (Miwa and Carrasco, inary teaching hospital, were retrospectively
2011; Guzman and Kapatkin, 2021). In addition, the analyzed over eight years (2013-2020). The inclu-
muscles of the hind limbs are strong, and the loco- sion criteria included cases with described
motion is particularly based on jumping (Miwa and management, and plain radiographs confirmed the
Carrasco, 2011; Meredith, 2016). fracture. The exclusion criteria were descriptive
cases without images.
The cause of fracture in pet rabbits and hares is
usually associated with a traumatic event (Fettinger The following information was taken into ac-
et al., 2010; Miwa and Carrasco, 2011; Pećin et al., count: patient signalment (sex; body mass; age, in
2015; Sasai et al., 2015). Improper handling can in- case of age not provided, the animal was classified
duce fractures or luxation of the lumbar vertebrae or as young or adult according to opened or closed phy-
hind limbs (Brown, 1997), even in animals with nor- sis on x-ray); cause of the fracture; involvement of
mal bone density (Brown, 1997; Meredith, 2016). one or more bones of the appendicular and/or axial
Fractures in rabbits are often complex with multiple skeleton; management of the case. The fractures of
fragments, but bone healing may occur quickly (Har- the appendicular skeleton bones were classified as
court-Brown, 2002). follows: affected bone; closed or open; complete
(both cortices disrupted) or incomplete (only one
The principles of surgical treatment and tech- cortex disrupted); simple (transverse, oblique, spiral)
niques used in small animals have been used in or multifragmentary fracture (more than two frac-
clinical cases of fractures in rabbits and hares (Har- tured fragments, which can be a reducible wedge,
court-Brown, 2002; Pećin et al., 2015; Kawamoto et nonreducible wedge, or segmental); location (proxi-
al., 2018; Sasai et al., 2018; Miwa and Carrasco, mal third, middle third, or distal third (epiphysis,
2011; Garcia-Pertierra, 2020), but there are chal- physis, and metaphysis). If the animal presented one
lenges associated with the anatomy and composition or multiple fractures were also verified. Those of the
of the bone tissue (Barron et al., 2010; Miwa and axial skeleton were classified to the location and
Carrasco, 2011; Guzman and Kapatkin, 2021). In ad- characteristics of the fracture.
dition, because rabbits are natural prey for many

Iran J Vet Med., Vol 16, No 4 (Fall 2022)

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Fractures in Rabbits and Hares Rodrigues, C.S.M.P et al.

The association between fracture site (appendicu- Results

lar or axial skeletons) and sex, and also the age (≤ 8
A total of 26 pet rabbits and five free-ranging
months age and young; > 8 months of age and adult)
hares met the inclusion criteria and were enrolled in
of the animals were compared using Fisher's exact
the study. Twenty-one (67.74%) of them had frac-
test (two-sided). The significance level was set at
tures in the appendicular skeleton (Table 1), nine
5%. The statistical analysis was performed with
(29.03%) in the axial skeleton (Table 2), and one
commercial statistical software (GraphPad Prism
(3.22%) in both skeletons, which represented 5.75%
8.3.1®, San Diego, CA, USA).
of all rabbit admissions in the period. One hare
showed fractures that included bones in both skele-
tons; therefore, it was not included in the Tables.

Table 1. Fractures of the appendicular skeleton in rabbits and hares

Body
Age
No. mass Sex Fracture site Cause Fracture classification Treatment
(years)
(kg)
left humerus attack by closed, multifragmental, plate-rod con-
1 - adult -
(middle third) a dog reducible wedge struction
fall from one intramedul-
left humerus closed, multifragmental,
2 1.5 3,0 M owner's lary pin and two
(distal third) reducible wedge
arms cerclage wires
radius: closed, complete,
right ra- conservative -
transverse
3 - 0,8 M dius/ulna unknown external coapta-
ulna: closed, complete,
(middle third) tion
long oblique
one intramedul-
left femur (
closed, multifragmental, lary pin and
4 2.7 6 M proximal third unknown
reducible two cerclage
)
wires
left femur
two Kirschner
5 1.7 0,4 F (Salter-Harris unknown closed, complete
wires
type I)
left femur
6 3.0 1,0 M (Salter-Harris unknown closed, complete death
type I)
left femur
closed, multifragmental, two intramedul-
7 2.5 6 M (proximal unknown
nonreducible lary pins
third)
conservative -
left tibia closed, complete, long
8 0.6 0,5 M unknown external coapta-
(middle third) oblique
tion
right tibia open, complete, trans-
9* young 0 unknown euthanasia
(middle third) verse
left tibia (dis- open, complete, short
10 - young 0 unknown amputation
tal third ) oblique
one intramedul-
fall from
left tibia (dis- lary pin and
11 3.8 adult M owner's closed, complete, spiral
tal third) three cerclage
arms
wires
left tíbia (dis- attack by open, multifragmental,
12 - 0,7 F amputation
tal third) a dog nonreducible
left tibia (dis- open, multifragmental,
13 0.8 0,8 M unknown amputation
tal epiphysis) nonreducible
right tibia attack by right: open, multifrag- intramedullary
14 1.8 young F
(distal third) a dog mental segmental pin bilateral

340 Iran J Vet Med., Vol 16, No 4 (Fall 2022)

Rodrigues, C.S.M.P et al. Iranian Journal of Veterinary Medicine

Body
Age
No. mass Sex Fracture site Cause Fracture classification Treatment
(years)
(kg)
left tibia (dis- left: closed, complete,
tal third) short oblique
external fixator
right tibia hit by a open, multifragmental,
15 1.9 2 0 and two cer-
(distal third) vehicle reducible wedge
clage wires
right tibia hit by a open, multifragmental,
16 3.1 2 M external fixator
(distal third) vehicle nonreducible
right tibia open, complete, short
17 young - unknown death
(distal third) oblique
conservative -
right tibia hit by a
18 2.0 0,7 M closed, complete, spiral external coapta-
(epífise distal) vehicle
tion
foot conservative -
closed, multifragmental,
19 1.3 0,2 M right tarsus stuck in external coapta-
reducible
a hole tion
right 3rd met-
conservative -
atarsal bone closed, complete, trans-
20 2.9 1,5 M unknown external coapta-
(proximal verse
tion
third)
right 1st, 2nd,
3rd metatar- conservative -
open, complete, short
21 10 young M sal bone unknown external coapta-
oblique
(proximal tion
third)
*hare; M: Male; F: Female.

Table 2. Fractures of the axial skeleton in rabbits and hares

Body
Age Fracture classifica- Treat-
No. mass Sex Cause Fracture site
(Years) tion ment
(kg)
fall from a
left mandible body conserva-
1 1,3 young M height of 5 complete, transverse
tive
m
right and left mandibu- conserva-
2 - 3 M unknown complete, transverse
lar rami tive
conserva-
hit by a multifragmental, re-
3* adult - iliac wing tive –
vehicle ducible
cage rest
attack by
0.5 vertebral body com- euthana-
4 - F another vertebral column (L6)
pression sia
rabbit
vertebral body com- euthana-
5 2.6 adult F unknown vertebral column (L4)
pression sia
conserva-
fall from vertebral column (cau-
6 0.9 2 M complete, transverse tive –
cage dal epiphysis of L6)
cage rest
conserva-
vertebral body com-
7 1.7 adult M unknown vertebral column (L7) tive –
pression
cage rest
L3: caudal articular
process
hit by a vertebral column euthana-
8* - young F L4: vertebral body
vehicle (L3, L4, L5) sia
and transverse pro-
cess

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Fractures in Rabbits and Hares Rodrigues, C.S.M.P et al.

Body
Age Fracture classifica- Treat-
No. mass Sex Cause Fracture site
(Years) tion ment
(kg)
L5: transverse pro-
cess
Luxation between
L3 and L4
T11: vertebral arch
vertebral column (T8, T8 and T10: spinous
9* hit by a euthana-
3.3 adult M T10, T11) processes
vehicle sia
Luxation between
T11 and T12
*hare; M: Male; F: Female

The body mass ranged from 0.6 to 3.8 kg (mean Fracture classifications in appendicular and axial
2.1 kg ± 0.97). The average age was 1.83 years (± skeletons are given in Tables 1 and 2, respectively.
1.79), calculated from rabbits whose age was known. The exception was the hare that had fractures in the
Seven of the animals whose age was not provided axial skeleton (right mandible body - closed, com-
were classified as young and six as adults. All rabbits plete, transverse; right pelvic floor and ischium) and
were entire (unclear), being 58.06% (n=18) males, appendicular skeleton (right femur –closed, trans-
22.58% (n=7) females and 19.35% (n=6) there was verse, complete). Long bone fractures were found in
no identification. Fischer's exact test showed no sig- the humerus (n=2), radius/ulna (n=1), femur (n=5),
nificant association between fracture site and sex and tibia (n=12). Fractures involving the distal as-
(P=0.3618). Likewise, no association was observed pects of the limbs included the tarsus (n=1) and
between fracture site and age (P=0.427). metatarsus (n=2) bones. Except for one rabbit that
showed right and left tibia fractures, all the others
Including only the appendicular skeleton, the
had unilateral fractures. A total of 14 fractures were
causes of fractures were hit by a vehicle (14.28%;
closed (60.86%) and nine open (39.13%). All these
n=3), falling from the owner's arms (9.52%; n=2),
fractures were complete, being 56.52%% (n=13)
being attacked by a dog (14.28%; n=3), having the
simple and 43.47% (n=10) multifragmentary frac-
paw stuck in a hole (4.76%; n=1), and 57.14%
ture. The procedures used in the fractures of the
(n=12) having an unknown cause. Including only the
appendicular skeleton included osteosynthesis
axial skeleton, the causes of fractures were being hit
(42.85%; n=9), external coaptation (n=6; 28.57%),
by a vehicle (33.33%; n=3), falling from a height or
amputation (14.28%; n=3), euthanasia (n=1; 4.76%),
cage (22.22%; n=2), being attacked by another rabbit
and two animals died (n=2; 9.52%) (Figures 1 and
(11.11%; n=1), and 33.33% (n=3) having an un-
2).
known cause. Including both skeletons, one hare was
hit by a vehicle.

342 Iran J Vet Med., Vol 16, No 4 (Fall 2022)

Rodrigues, C.S.M.P et al. Iranian Journal of Veterinary Medicine

Figure 1. Mediolateral (a, c) and craniocaudal (d, e) radiographic views of the left tibia of a rabbit (no. 8). Long oblique
fracture (a, b) treated with external coaptation due to financial constraint, showing malunion in part compensated for by
remodeling of the bone (c, d) 35 days after surgery

Figure 2. Mediolateral (a, c) and craniocaudal (d, e) radiographic views of the left femur of a rabbit (no. 5). Salter-Harris
(type I) distal femur fracture stabilized with two Kirschner wires, showing advanced bone healing on the 15th day after
surgery

The fractures of the axial skeleton (n=11) in- cases, the rabbits were euthanized due to poor prog-
cluded vertebral column (54.54%; n=6), mandible nosis at presentation (Figure 3).
(27.27%; n=3) and pelvis (18.18%; n=2). All of them
The hare, whose fractures included bones of both
were closed fractures. Five fractures of the axial
skeletons, was euthanized.
skeleton were treated conservatively, and in four

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Fractures in Rabbits and Hares Rodrigues, C.S.M.P et al.

Figure 3. Lateral (a) and ventrodorsal (b) radiographic views of the vertebral column of a rabbit (no. 4). Observe the
vertebral compression fracture of L6

Discussion
Fractures accounted for 5.75% of the total rabbit exams, probably because most were young rabbits.
admissions over the eight years, being 67.74% in the Fractures due to metastasis of uterine adenocarci-
appendicular skeleton, 29.03% in the axial skeleton, noma, osteosarcoma, and rhabdomyosarcoma have
and 3.22% in both skeletons. The fractures in this been observed in rabbits (Sasai et al., 2015).
study were non-neoplastic and related to traumatic
The percentage of males (58.06%) was higher
events, mainly due to being hit by a vehicle
than females (22.58%), but 19.35% were unknown.
(22.58%), falling (12.9%), being attacked by another
Another study found 54.8% males and 45.2% fe-
animal (12.9%), having a paw stuck in a hole
males; however, in fractures associated with
(3.22%), and 48.38% had an unknown cause. On the
neoplasms, female rabbits were considered more
other hand, in a retrospective study with 210 pet rab-
likely to have a fracture (Sasai et al., 2015).
bits, 24.8% of the fractures were due to accidental
falls as a result of human error, 22.9% were related Including all fractures, the three fracture sites
to other causes, and 16.7% the cause was unknown more frequent were the tibia (35.29%), vertebral col-
(Sasai et al., 2015). In another retrospective study umn (17.64%), and femur (14.70%). On the other
with 28 pet rabbits, 70% had unknown causes, and hand, the vertebral column (23.2%), tibia (22.7%),
17% were related to a known trauma (Garcia- and femur (13.1%) were the most affected, consider-
Pertierra, 2020). All hares in the present study were ing non-neoplastic fractures in a study with 198
free-ranging, and most of them had been hit by a ve- rabbits (Sasai et al., 2015). Different types of trau-
hicle. However, the hares are game species in some matic events may influence the differences in
countries, and femur fractures have been related to findings. Considering only the appendicular skele-
shots (Fettinger et al., 2010). ton, the tibia followed by the femur was the most
fractured, as observed in other pet rabbit studies (Sa-
The mean age of the rabbits was 1.83 years. A
sai et al., 2015; Sasai et al., 2018). On the opposite,
study verified that one year was the age that most
in a retrospective study with 28 pet rabbits, the femur
fractures happened, supposedly due to the sexual
followed by the tibia was the most fractured (Garcia-
maturity of the rabbits (Sasai et al., 2015). Also, in
Pertierra, 2020). The highest proportion of fractures
another study that evaluated long-bone fractures in
in the hind limbs verified in this study and the others
rabbits, 75% had aged less than two years, and the
(Sasai et al., 2015; Garcia-Pertierra, 2020) has been
others were under six months (Garcia-Pertierra,
attributed to a considerable force exerted by the rab-
2020). The present study did not detect fractures re-
bits on the hind limbs (Sasai et al., 2015).
lated to neoplasia in the clinical and radiographic

344 Iran J Vet Med., Vol 16, No 4 (Fall 2022)

Rodrigues, C.S.M.P et al. Iranian Journal of Veterinary Medicine

The tibia fractures comprised 58.33% sim- Although this study was not focused on fracture
ples and 41.66% multifragmental, being 66.66% treatments, surgical treatment was used only in long
open fractures. A study on the rabbit's tibia showed bone fractures. Internal fixation methods, such as
that an oblique loading induced diaphyseal fracture those used in the current study, have been used in
and short duration loading induced comminuted rabbits and hares, but species-specific guidelines for
fracture (Hirsch et al., 1954). The simple fractures in fracture treatment are still lacking (Harcourt-Brown
the present study included short oblique (n=3), long and Chitty, 2013; Pećin et al., 2015; Garcia-
oblique (n=1), transverse (n=2) and spiral (n=2) frac- Pertierra, 2020). A study has successfully used sheep
tures. In mature rabbits, angulatory forces in the tibia xenograft and low-level laser therapy to treat seg-
caused transverse and oblique fractures with more mental bone defects induced in rabbits (Nazht et al.,
damage to soft tissues than the spiral forces, which 2021). Because of the financial constraints, con-
caused spiral fractures (Oni et al., 1988). This fact servative methods or even euthanasia were
probably justifies two short oblique fractures and sometimes used. Additionally, the amputation was
one transverse that had been open in the present done in three pet rabbits with severe open tibia frac-
study. tures. Limb amputation has been cited as an
economical solution for complex fractures, being
All femur fractures were closed, being two Salter-
well-tolerated more frequently when performed on
Harris Type 1, two multifragmental, and one trans-
the thoracic limb (Harcourt-Brown, 2002). How-
verse. A study showed that the force required to
ever, a study (n= 32) detected nineteen chronic
induce femoral fracture in rabbits was smaller than
complications and six deaths after limb amputation
tibia fracture, which was attributed to the femoral
in client-owned rabbits (Northrup et al., 2014).
shape (Hirsch et al., 1954). Comminuted fractures
may occur in rabbits due to traumatic events of high The primary limitation of this study was the in-
energy and low energy impacts (Miwa and Carrasco, complete data in medical records, which reduced the
2011). Just one animal had a tarsal fracture, which is number of animals in the inclusion criteria. Another
generally associated with the category of low-energy limitation was that the breed was not provided. How-
fractures; closed, slight soft tissue trauma, and ever, the findings in the study helped to understand
preservation of the blood supply (Harcourt-Brown the species'.
and Chitty, 2013).
In the axial skeleton, vertebral fractures were the Conclusion
most frequent (54.54%), being the lumbar region the the fractures resulted from a traumatic episode,
most affected. The lumbosacral region (L6–L7) is a which had an unknown origin, involving mainly the
common site of fracture or luxation in rabbits; the appendicular skeleton, the tibia the most affected
force applied by hind limbs during the escape can bone.
over-flex the vertebral column inducing the lesion
(Fisher et al., 2021). However, another study found Acknowledgments
L5, the site most affected by fractures (Sasai et al., The authors are grateful to CNPq (National Coun-
2015). These patterns were not verified in the current cil for Scientific and Technological Development -
study since the fractures occurred at different sites PIBIC and PQ no.301585/2017-2), and Finep (Fi-
from L4 onwards. However, most rabbits and hares nanciadora de Estudos e Projetos), no.
were euthanized due to injury severity. Regarding 01.12.0530.00).
the mandible fractures, one was caused by falling,
and the other had an unknown cause in rabbits. One Conflict of Interest
hare had a fracture due to being hit by a vehicle. In
The authors declared no conflict of interest.
general, mandibular fractures in rabbits have been
more frequently associated with dropping or leaping
from the owner's arms (Harcourt-Brown, 2002).

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