TECHNIQUE

Fracture Management in Hedgehogs (Disease Investigation & Management)

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Summary Information
Type of technique Health & Management / Disease Investigation & Management / Techniques:
Synonyms and Keywords --
Description

 

Before performing any clinical technique, the associated legal and ethical considerations should be consulted, knowledge of the potential complications/ limitations/ risk should be gained, and the level of expertise and qualification required must be ascertained.

Fracture management should be performed by a veterinarian or under veterinary direction.

  • An early decision should be made as to the required treatment, considering the type of fracture, any associated infection, whether limb salvage is possible or amputation will be required and whether a return to the wild is likely or if long-term care will be required (e.g. following amputation). (V.w5, V.w6)
  • Details of facilities and extra care required for amputees may be found in Erinaceus europaeus - West European Hedgehog Long Term Care

NOTE:

FRACTURE MANAGEMENT

Leg fractures:

  • Opinions differ regarding the optimum methods for treating long bone fractures in hedgehogs. It is important to consider the hedgehog's ability to roll up, which increases the risk of limb dressings and fixators being loosened or dislodged. 

    • Some authors believe that, due to the rolling-up mechanism as well as the position of the bones only pinning is suitable for treatment of fractures (B291.12.w12) and that external fixators cannot be used (J15.21.w1)
      • "The only treatment suitable for fractures is pinning. This is due to the way the bones of the extremities are positioned and angled as well as to the strong muscular power when rolling up, which make fixation and stabilisation of the fracture extremely difficult. External fixation and bandage have also not proven to be effective."  (B291.12.w12)
    • Other authors consider that splints and casts are suitable for distal limb fractures and point out that while pinning is suitable for some fractures of the humerus and femur internal fixation may be contraindicated due to the presence of contamination or infection at the time the hedgehog is presented. (B284.6.w6)
  • While simple fractures may be pinned more complicated fractures may require internal and external fixation, excision arthroplasty, or amputation.(J60.1.w2, B284.6.w6, D107)
  • External fixators (extra-cutaneous fixation) may be considered for difficult cases. (J60.1.w2)
  • "Long bone fractures can be stabilised with intramedullary pins (external fixators cannot be used as they would be dislodged by the orbicularis muscle when rolling up)". (J15.21.w1)
  • Limb amputation is an option in limb fracture treatment. (J60.1.w2, B284.6.w6); this may be the only option with grossly infected fractures. (D107)
  • The option of euthanasia may also be considered if treatment is unlikely to lead to release.(B284.6.w6) 

Splints and casts

  • Simple fractures may be plastered.(D107)
  • Simple fractures of the tibia, radius, ulna, metatarsal or metacarpal bones may be stabilised by casting with plaster of Paris. (B151)
  • Coaption splints and casts may be used on fractures of the distal limb (radius, ulna, tibia, metatarsals, metacarpals. (B199, B284.6.w6, J60.1.w2)
  • Plaster of Paris, synthetic casting materials and rigid splints may be used. (B284.6.w6, J60.1.w2)
  • Particular case should be taken to keep dressings as dry and clean as possible. (B284.6.w6)
  • Foam-padded aluminium strips may be used for splinting. (B257.2.w3)

Pinning

  • Intramedullary pins may be used for fractures of the larger long bones. (B156.7.w7) 
    • A hypodermic needle may be used as an intramedullary pin to stabilise fractures of the femur or humerus. (J60.1.w2, B151)
  • Internal fixation techniques are contraindicated in fractures which are compound, contaminated or frankly infected. (B284.6.w6)

External fixator

  • Compound fractures (tibia, radius and ulna) may be stabilised with an external fixator; this allows treatment of associated soft tissue wounds, even if infected. (B151)
    • Rolling up tends to loosen or dislodge dressings and external fixators. (B284.6.w6)

Amputation

  • Limb amputation is an option in limb fracture treatment. (J60.1.w2, B284.6.w6, D107)
  • Amputation, if required (e.g. with grossly contaminated fractures), should take place in the proximal limb (for example through the proximal 1/3 of the femur, proximal 1/3 of the humerus, or the shoulder joint), to minimise risk of trauma to the stump.(D107, B337.3.w3)
    • Infection may be more common following front leg amputation than hind leg amputation. (B337.3.w3)
    • Hedgehogs with an amputated limb are not considered suitable for release to the wild as front limb amputees have reduced mobility and hind limb amputees have a reduced ability to groom the affected side, therefore have greater problems with external parasites such as mites. (D107, B284.6.w6, B337.3.w3) Such individuals may be suitable for permanent captive management in an escape-proof garden or large enclosure (See: Erinaceus europaeus - West European Hedgehog Long Term Care).
    • Regular inspection for external parasites is essential following amputation, as well as treatment and/or prophylactic use of an appropriate parasiticide (e.g. Ivermectin). (B337.3.w3)

Crushed feet:

  • These are compound fractures, generally highly infected and unsalvageable by the time of presentation. (B151, B284.6.w6)
  • Amputation is likely to be the best treatment. (B284.6.w6, B151)

Jaw fractures:

  • Wiring of both upper and lower jaws fractures may be possible. (B151, D107)

  • If the upper jaw is fractured then the palate is often torn and requires suturing.(B151)

  • Hand feeding will be required during healing. (D107)

Nasal fractures:

  • Fractured turbinates may cause a permanent reduction in the ability to smell; this would compromise the hedgehog's ability to forage in the wild.(J15.21.w1, D107)
  • Traumatic palatine injuries carry a guarded prognosis. (J15.21.w1)
  • N.B. Damage to the snout may lead to serious respiratory distress as hedgehogs are reluctant to mouth-breathe. (J15.21.w1)
    • Olbas oil and inhalations of eucalyptus and menthol may ease the breathing. (D107)
  • Supportive care during healing includes fluids until the hedgehog is able to accept liquid feed and then hand feeding until it can smell sufficiently to feed itself. (D107)
  • NSAID treatment is recommended to reduce swelling. (D107)
  • Antibiotic cover should be given. (NSAIDs)

Spinal fractures:

  • Radiography is required to confirm the diagnosis. (J15.21.w1, B151, B156.7.w7, B284.6.w6, D107)
  • An important differential diagnosis is Hedgehog Pop-off Syndrome which is highly treatable.
  • Conservative treatment can be used as for spinal injuries in other species, i.e. keeping the hedgehog to see if there is an improvement as swelling reduces and nerve or muscle damage heals.
    • It is important to monitor output of urine and faces, empty the bladder manually if necessary, and to set a time limit after which, if recovery is not evident, euthanasia will be carried out. (D107, V.w5)

ANALGESIA IN FRACTURE MANAGEMENT

Appropriate analgesia using opiates or NSAIDs should be provided for individuals with fractures (B151, B284.6.w6, J60.1.w2). Suggested doses include:
  • Buprenorphine
    • 12 g/kg intramuscularly. (J60.1.w2)
    • 20-30 g/kg intramuscularly three times daily. (B284.6.w6)
    • 0.05-0.1 mg/kg intramuscularly every 8-12 hours. (D107)
  • Carprofen
    • 4-10 mg/kg intramuscularly. (J60.1.w2)
    • 5-10 mg/kg once daily subcutaneously or twice daily orally. (B284.6.w6)
    • 5mg/kg subcutaneously once daily. (D93)
    • 4 mg/kg subcutaneous injection, once daily for three days. (J15.21.w1)
    • 4 mg/kg subcutaneously at 24-36 hour intervals. (D107)
  • Flunixin meglumine
    • 1 mg/kg daily for three days intramuscularly. (J60.1.w2)
    • 2 mg/kg subcutaneously or orally once daily. (B284.6.w6)
    • 2 mg/kg intramuscularly once daily for a maximum of five days. Maximum five days of therapy. (D93)

N.B. 

  • Many drugs are not registered for use in particular species and care should be taken in their use, with proper regard for possible toxic effects. Consideration should be give to relevant legislation regarding the use of drugs.
  • In the UK, guidelines regarding the use of drugs are set out in the Royal College of Veterinary Surgeons Guide to Professional Conduct 2000: (See: LCofC1 - RCVS Guide to Professional Conduct 2000 - Choice of Medicinal Products).
Appropriate Use (?)
Notes --
Complications/ Limitations / Risk
  • There are limitations on suitable methods of fracture repair, particularly for due to the ability of hedgehogs to curl up, which may dislodge some externally applied fracture stabilisers.
  • Internal fixation may be contraindicated due to the presence of contamination or infection at the time the hedgehog is presented. (B284.6.w6)
  • The option of euthanasia may be considered if treatment is unlikely to lead to release.(B284.6.w6)
Equipment / Chemicals required and Suppliers
  • Intermedullary pins
  • Casting and splinting materials.
Expertise level / Ease of Use
  • Procedure should only be undertaken by an individual with appropriate clinical training and practical experience; this would usually be a veterinarian or someone with advanced veterinary technician training.
Cost/ Availability Costs may be variable depending on the type of treatment required.
Legal and Ethical Considerations In some countries there may be legislation restricting the use of this type of technique to licensed veterinarians. For example in the UK: "The Veterinary Surgeons Act 1966 (Section 19) provides, subject to a number of exceptions, that only registered members of the Royal College of Veterinary Surgeons may practice veterinary surgery." (See: LCofC1 - RCVS Guide to Professional Conduct 2000 - Treatment of Animals by Non-Veterinary Surgeons).

Use of Drugs (Medication):

  • Before administration of any drug the manufacturer's datasheet must be consulted regarding operator safety, relevant withdrawal times etc.
  • Many drugs are not registered for use in particular species and care should be taken in their use, with proper regard for possible toxic effects. Consideration should be give to relevant legislation regarding the use of drugs.
  • In the UK, guidelines regarding the use of drugs are set out in the Royal College of Veterinary Surgeons Guide to Professional Conduct 2000: (See: LCofC1 - RCVS Guide to Professional Conduct 2000 - Choice of Medicinal Products).
Authors Becki Lawson (V.w26)
Referee Debra Bourne (V.w5), Suzanne I. Boardman (V.w6)
References B150.w1, B199, B228.11.w11, B257.2.w3, B284.6.w6, B337.3.w3, J15.21.w1, J60.1.w2, J138.60.w1, P8.3.w2, D92, D107, V.w26, V.w44

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