DISEASE SUMMARY PAGE

Elbow Luxation in Rabbits and Ferrets

Summary Information
Diseases / List of Physical / Traumatic Diseases / Disease summary
Alternative Names  
Disease Agents
In Rabbits
  • Trauma. (B602.35.w35, B609.2.w2)
    • Note: there is not always a history of trauma. (B602.35.w35)
  • Commonly due to a rabbit catching its leg in cage flooring and then moving suddenly. (B601.17.w17)
In Ferrets
  • Elbow luxation can occur spontaneously or secondary to trauma. (J213.5.w4)
    • It is thought that elbow luxation may be an inherited condition, but commonly noticed by owner after trauma. (J513.8.w2)
Infectious Agent(s) --
Non-infectious Agent(s) --
Physical Agent(s)
General Description
Clinical signs
In Rabbits
  • Non-weight-bearing lameness. (B601.17.w17, B602.35.w35)
  • Elbow joint very swollen and painful. (B601.17.w17, B602.35.w35)
  • The rabbit may be anorexic due to pain. (B609.2.w2)
In Ferrets
  • Ferrets present with non-weight-bearing lameness of one or both forelimbs. (J213.5.w4)
  • The affected elbow joint is swollen and painful. (J213.5.w4)
Further Information
In Ferrets
  • This is fairly common in ferrets. (B631.19.w19, B631.23.w23, J213.5.w4)
  • Ferrets can have a unilateral or a bilateral elbow luxation. (B631.23.w23, J513.8.w2)
  • This can be a medial or lateral luxation. (J213.5.w4)
Diagnosis
In Ferrets
  • Clinical signs and history can help with diagnosis. (J213.5.w4)
  • Radiographs of the elbows in cranio-caudal and lateral views. (J213.5.w4)
Treatment
In Rabbits
  • Closed reduction and splinting
    • Reduce the dislocation (closed reduction). (B601.17.w17, B602.35.w35)
      • Anaesthetise the rabbit; ensure that the anaesthetic protocol provides sufficient muscle relaxation. (B536.131.w131)
      • For luxation with the anconeal process still within the olectranon fossa:
        • Extend the leg slightly to fix the anconeal process. (B536.131.w131)
        • Abduct and internally rotate the antebrachium (forearm), exerting pressure on the lateral aspect of the radial head to achieve joint reduction. (B536.131.w131)
      • For luxation with the anconeal process lateral to the epicondyl:
        • Markedly flex the elbow, while internally rotating and abducting the antebrachium. (B536.131.w131)
        • If necessary, use a towel clamp or Lewis bone clamp through the skin into the olecranon, and use this to distract the ulna caudally. (B536.131.w131)
      • Check that the joint has reasonable collateral stability. (B536.131.w131)
      • Take radiographs to confirm the position of the joint surfaces and whether there is any subluxation. (B536.131.w131)
        • Once the elbow is reduced, maintain the elbow in extension. (B602.35.w35)
      • Note that if the dislocation is easy to reduce, it may also be easy to re-luxate. (B602.35.w35)
    • Splinting
      • Use an aluminium rod (e.g. spica splint), Vet-lite or Orthoplast.
      • Ideally, the shoulder joint should be immobilised but this is very difficult in rabbits. (B602.35.w35, B609.2.w2)
      • A splint can be placed to mid-humerus level. (B602.35.w35)
  • Internal fixation
    • This is often needed. (B602.35.w35, B609.2.w2)
    • Use a transarticular pin, placed from the caudal ulna into the distal humerus to keep the joint reduced. (B601.17.w17, B602.35.w35)
    • Place a light Orthoplast or Vet-lite splint to prevent full weight-bearing on the limb and minimise movement. (B601.17.w17, B602.35.w35)
    • Remove the pin after three to four weeks, (B601.17.w17, B602.35.w35) maintain the splint for a further two to three weeks (B602.35.w35) three to four weeks. (B601.17.w17)
    • If this approach is unsuccessful, a transarticular external fixator can be used. (B602.35.w35)
  • External fixator
    • Place a transarticular fixator across the joint. (B601.17.w17
    • After two to four weeks, remove the external fixator and apply a splint. (B601.17.w17)
In Ferrets

A variety of methods have been described for treatment in a discussion of this condition (J513.8.w2) as indicated below. Note: The number of options suggested and lack of consensus on the preferred treatment probably indicates that there is no ideal treatment. (V.w5)

  • Reduction and stabilization of the joint. (J213.5.w4)
    • Closed reduction can be carried out under sedation or general anaesthesia. A padded bandage should be applied, with a spica splint; this should reduce the movement of the scapulohumeral joint. (J213.5.w4)
    • Note: If closed reduction is performed, the luxation is likely to recur. (B631.23.w23, J213.5.w4)
  • Splinting
    • Sedate the ferret and take radiographs (B631.23.w23), then reduce the elbow. (J513.8.w2)
    • This should be done with the joint in flexion not in extension. (J513.8.w2)
    • One approach is to wrap the bandage around the neck, then apply cast padding around the elbow and elastic bandage to wrap the flexed elbow to the neck. (J513.8.w2)
      • This bandage can be applied bilaterally (to both elbows) if the condition is bilateral: temporary cage re-arrangement is necessary while the front legs are splinted in this manner. (J513.8.w2)
    • Bandages may be left for fourteen days initially but may needed for as long as six weeks. (J513.8.w2)
      • Ensure the legs are checked for oedema on a weekly basis. (J513.8.w2)
      • Physiotherapy should be carried out if the elbow is not painful. (J513.8.w2)
      • Swimming in a warmed pool can also help. (J513.8.w2)
      • Splinting has a high success rate. (J513.8.w2)
  • Internal fixation
    • The preferred method of managing a luxated elbow is with reduction internal fixation. (J213.5.w4)
    • Open surgical technique is preferred over closed, as visualisation is improved during surgery. (J213.5.w4)
    • Consequences to consider pre-surgery with the owner include (J513.8.w2)
      • Stabilization failure. (J513.8.w2)
      • Cost of the surgery. (J513.8.w2)
      • Infection post surgery. (J513.8.w2)
      • Degenerative arthropathy if the luxation is old. (J513.8.w2)
    • A lateral surgical approach to the elbow is recommended. (J213.5.w4)
    • The luxation should be manually reduced. (J213.5.w4)
    • Stabilize the elbow with intramudullary pins and stainless steel wire. (J213.5.w4)
    • Transarticular intramudullary pins (B631.23.w23) can be tied into a type one, transarticular acrylic fixator. (J213.5.w4)
    • Ensure the elbow is at 100 to 110 degrees flexion. This will allow the pin to fix on the proximal end of the ulna and maintain the length of the limb. (J213.5.w4)
    • A bandage should be placed over the top. (J213.5.w4)
      • A splint can be used for support. (B631.23.w23)
  • External fixator
    • K-wires have been used on a ferret with bilateral luxated elbows. They were placed down the humerus and seated in a transarticular fashion into the proximal ulna. K-wire was then placed on the distal humerus and proximal radius and unified with a lateral type one acrylic fixator on both elbows. 5/0 monofilament absorbable suture was used for closure. (J213.5.w4)
      • The owner gave physiotherapy for five minutes, several time daily. (J213.5.w4) 
      • Long term recovery was good, with only small amount crepitus in one of the joints. The ferret also had good movement in both joints. (J213.5.w4)
  • A non-absorbable suture can be used to keep the articulation in a flexed position, (keeping it slightly loose) which has worked well in ferrets. (J513.8.w2)
  • Ankylosis
    • If the elbow is severely luxated, ankylosis may be the best option: ream the cartilage and perform a bone graft. (J513.8.w2)
  • Amputation
    • Ferrets do well with one limb amputated. The surgical procedure is the same as in cats and dogs. (B631.23.w23)
  • Note: Osteomyelitis is a possible complication post-trauma or post-surgery. The pathology and clinical signs are similar to those of cats and dogs. The treatment is also similar to cats and dogs. (J213.5.w4)
    • Aerobic and anaerobic culture should be carried out and antibiotics should be given as appropriate. (J213.5.w4)
Post-surgical radiography
  • Radiographs should be carried out three weeks after surgery. (J213.5.w4)
  • In a ferret in which luxated elbows were managed without treatment, DJD (degenerative joint disease) developed. (J513.8.w2)
    • Cosequin can be given to these cases. (J513.8.w2)
    • Note: DJD has been reported in ferrets that have had surgery as well. (J513.8.w2)
    • Osteoarthritis is not thought to be a major problem if the luxation is left, as there is little bone contact within the joint. (J513.8.w2)
Associated Techniques
Host taxa groups /species
Disease Author Debra Bourne MA VetMB PhD MRCVS (V.w5); Bridget Fry BSc, RVN (V.w143)
Referees John Chitty BVetMed CertZooMed MRCVS (V.w65)

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