TECHNIQUE

Bone Plating in Rabbits (Disease Investigation & Management - Treatment and Care)

Summary Information
Type of technique Health & Management / Disease Investigation & Management / Techniques:
Synonyms and Keywords --
Description Editor's Note: 
  • Information on this page is to be used together with information given in the "Treatment" section of the page Fractures in Rabbits and with information given in the page Treatment and Care.
  • This page is intended to provide the reader with information of particular importance for the treatment of lagomorphs. It does not provide details of the approach to different bones for pin placement.
  • The reader should use the information in this text alongside their own experience in orthopaedic surgery and should consult relevant texts on small animal orthopaedic surgery as required.
Pre-operative preparation
  • Give pre-operative analgesia 1-2 hours before surgery. (J213.5.w3)
  • Give pre-operative antibiotics 1-2 hours before surgery. (J213.5.w3)
  • Anaesthetise the rabbit. See: Treatment and Care - Anaesthesia and Chemical Restraint - Lagomorph Anaesthesia
  • Prepare the limb for surgery.
Bone plating
  • Anaesthetise the rabbit.
  • Prepare the leg for aseptic surgery.
  • Reduce the fracture. (P112.1993.w1)
  • Remove soft tissues and periosteum over the bone as required. (B602.35.w35)
  • Place a plate of an appropriate size on the bone.
  • Use a sharp, straight drill bit and avoid wobble to reduce the chance of screw holes that are too large, and iatrogenic fractures. (P112.1993.w1)
    • Use the drill guide properly to ensure the hole is drilled in the correct location relative to the plate hole, otherwise the threads may be stripped as the screw is tightened. (P112.1993.w1)
  • Carefully tap the holes with frequent cleaning of the tap flutes. (P112.1993.w1)
  • Insert the screws delicately to prevent (a) stripping of the threads; (b) iatrogenic fractures. (P112.1993.w1)
Intramedullary Polymethyl methacrylate method
  • Polymethyl methacrylate can be injected into the medullary cavity of the bone to increase screw purchase and increase fracture stability. (P112.1993.w1)
    • Inject the PMM into the medullary cavity of the bone fragments. (P112.1993.w1)
    • Reduce the fracture. (P112.1993.w1)
    • Apply the plate with the screws placed through both bone and cement. (P112.1993.w1)
Nursing and post-operative care
  • See: Treatment and Care - Surgery - Post-operative care
  • Analgesia is necessary at the time of stabilisation and then continued post-operatively as necessary. (B606.10.w10)
    • Give pre-operative analgesia 1-2 hours before surgery. (J213.5.w3)
    • NSAIDs are appropriate following fracture repair. (B600.5.w5)
  • Antibiotics as necessary. (P112.1993.w1)
    • Give pre-operative antibiotics 1-2 hours before surgery. (J213.5.w3)
    • Give antibiotics for 3-5 days post-surgery. (J213.5.w3) for seven to ten days. (B606.10.w10)
  • Environment: clean and stress-free. (B606.10.w10)
    • Minimise the time in a hospital environment, which rabbits generally find stressful. (P112.1993.w1)
    • Provide a warm, quite environment. (P112.1993.w1)
  • Diet: nutritional support is important. (N12.38.w1)
    • Syringe feed with a herbivore recovery diet. (N12.38.w1)
    • Force feeding may be necessary if there is anorexia (make sure the rabbit is receiving appropriate analgesia, because pain is often manifested as anorexia). (B606.10.w10)
  • Fluids: oral or intravenous fluid therapy may be needed. (N12.38.w1)
  • Bedding: thick towels, torn-up paper or newspaper is recommended post-operatively. (J213.5.w3)
  • Monitoring (general):
    • Assess for pain.
    • Check food consumption. (J213.5.w3)
    • Check faecal output. (J213.5.w3)
  • Monitoring (fracture repair):
    • See: Imaging in Lagomorph Diagnosis and Treatment 
    • Re-radiograph the fracture every three to four weeks to check on the healing process. (B606.10.w10)
      • Radiograph at four weeks then every week. (P112.1993.w1)
    • Callus formation takes a minimum of ten days and an uncomplicated fracture may heal by six weeks. (B606.10.w10)
    • Remove any implants only after there is radiographic evidence of fracture union. (P112.1993.w1)
    • Optimally, plates are removed after three to four months (in clinical situations with comminuted fractures and compromised blood supply). (B602.35.w35)
    • Note: Staged removal may be needed, requiring additional surgeries and adding to expense. (B602.35.w35)
Appropriate Use (?)
  • Plates provide rigid internal fixation and anatomic alignment, and do not interfere with joint function. (P112.1993.w1)
  • May be useful for complicated fractures. (B601.17.w17)
  • May be useful for humerus and femur fractures. (J213.5.w3)
    • May be useful for open fractures of the femur or humerus where use of an external fixator may be difficult due to the mass of overlying soft tissue. (B602.35.w35)
Notes For fractures occurring in practice, removal of the plate probably should be carried out at about three to four months. (B602.35.w35) 
Complications/ Limitations / Risk
  • Placing a plate on the bone requires removal of soft tissues and periosteum over the bone, which can further compromise blood supply (already affected by fracture, particularly if comminuted). (B602.35.w35)
  • The thinness of rabbit bone cortices makes placement of screws difficult. (B601.17.w17, B602.35.w35)
    • Iatrogenic fracture may occur while screws are being placed. (P112.1993.w1)
  • If screws are insecure, threads may strip, pins pull out and plates come away from bone, causing failure of fixation. (B601.17.w17)
  • Properly applied bone plates may give excessive protection of the fracture; the lack of load may result in delayed healing or even non-union of the bone. (B601.17.w17, B602.35.w35)
    • Staged removal may be needed, requiring additional surgeries and adding to expense. (B602.35.w35)
    • Optimally, plates are removed after three to four months (in clinical situations with comminuted fractures and compromised blood supply). (B602.35.w35)
Equipment / Chemicals required and Suppliers
  • Small bone plates are needed - 2.7 mm and smaller. (B601.17.w17)
  • Veterinary Cuttable Plates (Synthes Ltd., Wayne, PA, USA) provide flexibility in choosing plate length and stiffness. (B601.17.w17, P112.1993.w1)
    • Depending on the plate chosen, these can be used with 1.5 or 2.0 mm screws, or with 2.0 or 2.7 mm screws. (B601.17.w17, P112.1993.w1)
    • Cuttable plates have more screw holes for their length than standard plates (holes closer together. (B601.17.w17, P112.1993.w1)
    • The plate can be cut to the length needed. (P112.1993.w1)
Expertise level / Ease of Use
  • Bone plating is a technically difficult operation, requiring specialised training. (P112.1993.w1)
Cost/ Availability

The costs of a surgical operation include those associated with: (J15.30.w1)

  • Pre-operative diagnostics (e.g. radiography, ultrasonography, blood tests)
  • Anaesthesia.
  • Perioperative medication (e.g. analgesics, antibiotics, fluids).
  • Surgical preparation (of the operating theatre and the patient, including staff time).
  • Consumables and equipment.
  • Time of the surgeon and assistant(s).
  • Post-operative hospitalisation.
Costs of bone plating include:
  • Plates, screws and specialised equipment, which are expensive. (B602.35.w35, P112.1993.w1)
  • Costs associated with extensive surgical exposure and tissue dissection, requiring long surgical time. (P112.1993.w1)
  • Costs associated with post-operative and follow-up radiographs.
  • Costs associated with further anaesthesia and operations for staged plate removal. (B602.35.w35)
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).
Author Debra Bourne MA VetMB PhD MRCVS (V.w5)
Referee John Chitty BVetMed CertZooMed MRCVS (V.w65)
References B600.5.w5, B601.17.w17, B602.35.w35, B606.10.w10, J15.30.w1, J213.5.w3, N12.38.w1, P112.1993.w1

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