Need opinions on X-Rays. Broken Leg?

[pretzel's_mom]

Pretzel fell yesterday from about 5 feet and he started limping. I took him to the vet the same day and the vet said the xrays show that he has a broken leg and he needs surgery, but they are unable to perform surgery.

I sent the xray images to another vet, and they said they don't see any fractures.

I would love some opinions from someone knowledgeable if this looks like a broken / dislocated leg, if the injury could heal and what should I do.

Pretzel is about 13 weeks old and I plan to release him back in my yard when he becomes an adult.

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[SamtheSquirrel2018]

Pretzel fell yesterday from about 5 feet and he started limping. I took him to the vet the same day and the vet said the xrays show that he has a broken leg and he needs surgery, but they are unable to perform surgery.

I sent the xray images to another vet, and they said they don't see any fractures.

I would love some opinions from someone knowledgeable if this looks like a broken / dislocated leg, if the injury could heal and what should I do.

Pretzel is about 13 weeks old and I plan to release him back in my yard when he becomes an adult.

Hi Pretzel's_Mom and thank you for finding The Squirrel Board. Which leg is Pretzel favoring?

I must give you a disclaimer and that is that I am not a Veterinarian or a Radiologist; but nevertheless, I did look at Pretzel's radiographs and it appear to me that Pretzel does, indeed, have a fracture that involves the distal 1/3 of the Right Fibula. The alignment of the ends of this bone are displaced and it also appears that the fracture ends are somewhat pointed which suggests a spiral type of fracture which commonly occurs when there is additional twisting loads on a bone.

I wish that the x-ray tech had gotten views of both hind extremities in the Cranial to Caudal direction or in the Caudal to Cranial direction as either of these views would show the Fibula and the Tibia running parallel to each other and would give us more information of the degree of misalignment, any possible angulation (there doesn't seem to be much if any from the views submitted) and displacement (there is considerable displacement approximately at least equal to the entire diameter of the bone at the fracture site).

There is some relatively good new with the fracture involving only the Fibula which is the smaller of the two somewhat parallel running leg bones of the rear or hind extremity. The other and more massive bone is the Tibia. The Tibia is the primary weight bearing bone of the hind leg while the Fibula pretty much "hangs on" but it is subject to mainly twisting loads and that is how the fracture appears to me to have occurred.

The treatment for this may simply be to let it heal while minimizing activity. A splint is certainly a possibility would seem to me to be the ideal option (but again, I am not a Vet). IMHO, surgery would be overkill! BUT, once more, I am not a Vet and I would strongly recommend that you have Pretzel evaluated by a Vet who is experienced and comfortable with orthopedic injuries. The Vet must of course be Squirrel friendly. A possibility may even be the original Vet. Do you recall what they said was fractured (do we agree?). Maybe they would be able to give Pretzel a light dose of inhaled anesthesia such as isoflurane and take the Cranial to Caudal x-rays for better visualization of the fracture and apply an appropriate splint all while Pretzel is sedated with the inhaled anesthesia! As this fracture heals, the fracture end will become more aligned as a part of bone healing is remodeling where some bone material is removed while other bone material is laid down.

A common misconception is that bones are simply "dead calcium" but in fact bones are actually highly vascular living tissues with a well endowed nerve network. Pain and bleeding at the fracture site is universal! There are some conflicting data as to whether or not use of NSAIDs such as Ibuprofen or Meloxicam might have adverse effects on fracture healing but no doubt, Pretzel has some significant pain. Maybe this Vet could also prescribe some pain medication (which may be an NSAID or other medication based upon their professional opinion and evidence).


I have attached links to copies of your radiographs with my addition of arrows marking the fracture ends. I could not seem to directly attach the pdf files I made to show the annotations.

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Please keep on with the updates.

Regards,
SamtheSquirrel

[SamtheSquirrel2018]

Hi Pretzel's_Mom:
I case you "lost" your thread, I just wanted to "bump" it back for you! It does appear that Pretzel has a fracture of his Right Fibula which is the smaller, non-weightbearing, bone in his right hind leg. A Vet visit is advisable but a splint, significant limitation of activity for 3-4 weeks and some pain medication may be adequate. I marked with red arrows what appears to be a fracture on your two x-ray films of the right hind limb and pelvis. I couldn't seem to directly upload the films I marked as they were made into pdf files to allow me to mark them. I place links to the marked films in my post.

I wish the best for Pretzel and for you, Pretzel's_Mom!
Regards,
SamtheSquirrel

[pretzel's_mom]

Hi SamtheSquirrel,

I wanted to express my heartfelt gratitude for your incredibly thorough, detailed, and thoughtful analysis of Pretzel's situation. Your expertise and genuine willingness to help are truly appreciated.

I made numerous calls to over 30 places in both my state and the neighboring one, but, regrettably, I was unable to find a vet who could put a splint on Pretzel's leg and release him back to me. Your insights and advice are invaluable, and I will follow your recommendation and give Pretzel some much-needed cage rest.

Even though you're not a veterinarian or radiologist, your analysis of Pretzel's x-rays is immensely helpful. Your explanation of the fracture involving the distal 1/3 of the Right Fibula and the type of fracture it appears to be is enlightening. The fact that the fracture involves the Fibula, which is not the primary weight-bearing bone, provides some relief.

I appreciate your insights into bone healing and the importance of pain management. I'll continue my efforts to find a vet or revisit the original vet for guidance on pain medication.

Lastly, thank you for attaching the links to the radiographs with your annotations. They're incredibly helpful for understanding the extent of the fracture.

I'll definitely keep you updated on Pretzel's progress. Your support means the world to us.

Kindest regards,
Pretzel & Pretzel's Mom

[SamtheSquirrel2018]

Hi SamtheSquirrel,

I wanted to express my heartfelt gratitude for your incredibly thorough, detailed, and thoughtful analysis of Pretzel's situation. Your expertise and genuine willingness to help are truly appreciated.

I made numerous calls to over 30 places in both my state and the neighboring one, but, regrettably, I was unable to find a vet who could put a splint on Pretzel's leg and release him back to me. Your insights and advice are invaluable, and I will follow your recommendation and give Pretzel some much-needed cage rest.

Even though you're not a veterinarian or radiologist, your analysis of Pretzel's x-rays is immensely helpful. Your explanation of the fracture involving the distal 1/3 of the Right Fibula and the type of fracture it appears to be is enlightening. The fact that the fracture involves the Fibula, which is not the primary weight-bearing bone, provides some relief.

I appreciate your insights into bone healing and the importance of pain management. I'll continue my efforts to find a vet or revisit the original vet for guidance on pain medication.

Lastly, thank you for attaching the links to the radiographs with your annotations. They're incredibly helpful for understanding the extent of the fracture.

I'll definitely keep you updated on Pretzel's progress. Your support means the world to us.

Kindest regards,
Pretzel & Pretzel's Mom

Thanks for your reply, Pretzel's Mom! Just out of curiosity, what did the original Vet say was fractured and what was the surgical procedure that was recommended? Also it would be beneficial to have radiographs with the either of the other suggested views because there could be significant angulation and/or displacement that cannot be seen with just the views already obtained although I would suspect that there would be minimal likelihood of needing to modify a plan of limiting activity with a smaller cage with low height, splinting if possible, and some pain relief. In a sense, the intact Tibia will effectively act as a splint to a significant degree but an external splint will help limit additional rotational loads (twisting) on the already fractured Fibula! We will all be awaiting updates on Pretzel!
Regards,
SamtheSquirrel

[pretzel's_mom]

Thanks for your reply, Pretzel's Mom! Just out of curiosity, what did the original Vet say was fractured and what was the surgical procedure that was recommended? Also it would be beneficial to have radiographs with the either of the other suggested views because there could be significant angulation and/or displacement that cannot be seen with just the views already obtained although I would suspect that there would be minimal likelihood of needing to modify a plan of limiting activity with a smaller cage with low height, splinting if possible, and some pain relief. In a sense, the intact Tibia will effectively act as a splint to a significant degree but an external splint will help limit additional rotational loads (twisting) on the already fractured Fibula! We will all be awaiting updates on Pretzel!
Regards,
SamtheSquirrel

Hello SamtheSquirrel,

I greatly appreciate your continued support and care. The original vet diagnosed Pretzel with a broken right leg at the ankle. They mentioned that the bones at the ankle are dislocated, and surgery is required to reposition them. However, the surgery is quite expensive, and they expressed doubts about Pretzel's ability to survive in the wild even after the surgery. They recommended to have him euthanized :(.

I was determined to explore every avenue to help Pretzel, so I requested the surgery. Unfortunately, the vet didn't feel comfortable performing it and advised me to find a specialist in orthopedic surgery.

The original vet provided x-ray images, but they didn't specify exactly what was wrong in the images. Your annotations on the x-rays have been incredibly helpful in pinpointing the small fracture, and I can't thank you enough for that clarity.

I've found another squirrel-friendly vet, and we have an appointment scheduled for Tuesday. I will certainly keep you updated on the outcome and the path forward.

Thank you once again for your unwavering care and assistance. Your support is deeply appreciated, both by me and Pretzel.

Warmest regards,
Pretzel & Pretzel's Mom

[SamtheSquirrel2018]

Hello SamtheSquirrel,

I greatly appreciate your continued support and care. The original vet diagnosed Pretzel with a broken right leg at the ankle. They mentioned that the bones at the ankle are dislocated, and surgery is required to reposition them. However, the surgery is quite expensive, and they expressed doubts about Pretzel's ability to survive in the wild even after the surgery. They recommended to have him euthanized :(.

I was determined to explore every avenue to help Pretzel, so I requested the surgery. Unfortunately, the vet didn't feel comfortable performing it and advised me to find a specialist in orthopedic surgery.

The original vet provided x-ray images, but they didn't specify exactly what was wrong in the images. Your annotations on the x-rays have been incredibly helpful in pinpointing the small fracture, and I can't thank you enough for that clarity.

I've found another squirrel-friendly vet, and we have an appointment scheduled for Tuesday. I will certainly keep you updated on the outcome and the path forward.

Thank you once again for your unwavering care and assistance. Your support is deeply appreciated, both by me and Pretzel.

Warmest regards,
Pretzel & Pretzel's Mom

Hello again P & PM:

I'm glad that you were finally able to get an appointment with a Squirrel-Friendly Vet scheduled and relatively soon, too! With my recent disclaimer still fresh in your mind, I don't see any compelling evidence for a dislocation, only for the fracture of the distal fibula. One thing that the Vet can do is check more thoroughly for this with Pretzel sedated with an inhaled anesthetic and this would also be a perfect tine to get the radiographs in the Cranial-Caudal or Caudal-Cranial directions if you Vet concurs.

The additional views would also help to rule-out the possibility of there also being a fracture of the the distal Tibia which would of course, complicate matters considerably!

Of course, I am NOT trying to get between you, Pretzel and Pretzel's Vet and your Vet is the professional and will discuss his impressions and recommendations with you!

It's technically not really a "small" fracture as it completely through the bone with 100% displacement in what appears to be a spiral type BUT, it is the Fibula and most likely it will heal well with a splint to help prevent further rotational movement and to hold the ankle joint immobile or at least with restricted movement of the ankle. My other suggestion would be as I previously mentioned and that is for a general restriction in movement and no jumping if at all possible which is best facilitated with decreasing the Pretzel's cage size and especially its height. The restrictions associated with splinting and cage size are not without potential psychological effects and one thing the Vet may consider along with pain medication might be Gabapentin as this can not only complement pain management but help with anxiety and fear. Gabapentin has been used quite effectively and safely with Squirrels and other rodents!

Regards,
SamtheSquirrel

[SamtheSquirrel2018]

Hi Pretzel's Mom:
How is Pretzel doing? How did everything go at the Vet visit?
Regards,
SamtheSquirrel

[pretzel's_mom]

Hi Pretzel's Mom:
How is Pretzel doing? How did everything go at the Vet visit?
Regards,
SamtheSquirrel

Hi SamtheSquirrel,

Thank you so much for your unconditional care. And apologies about my delayed response. Taking care of Pretzel has been more than a second full time job. He wants me to be next to him all the time, and if I use my phone, he tries chewing it off. What a rascal! :)

The vet allowed me to touch Pretzel's left and right ankles and compare them. The right ankle was very wiggly and they put a bandage that Pretzel has to keep on for the next 4 weeks. In 4 weeks we are going for another set of xrays and the vet will assess how he has healed.

The vet also said that Pretzel has a good chance to recover well with the bandage and have a good quality of life when we will release him back in the yard.

I did ask for Gabapentin prescription, but the vet did not feel comfortable prescribing it, so we got Torbutrol + Liqui-tinic syrup instead. For pain management, we got prescribed Meloxicam 1.5mg/ml. What do you think about those medications?

Warmest regards,
Pretzel & Pretzel's Mom

[SamtheSquirrel2018]

Hi SamtheSquirrel,

Thank you so much for your unconditional care. And apologies about my delayed response. Taking care of Pretzel has been more than a second full time job. He wants me to be next to him all the time, and if I use my phone, he tries chewing it off. What a rascal! :)

The vet allowed me to touch Pretzel's left and right ankles and compare them. The right ankle was very wiggly and they put a bandage that Pretzel has to keep on for the next 4 weeks. In 4 weeks we are going for another set of xrays and the vet will assess how he has healed.

The vet also said that Pretzel has a good chance to recover well with the bandage and have a good quality of life when we will release him back in the yard.

I did ask for Gabapentin prescription, but the vet did not feel comfortable prescribing it, so we got Torbutrol + Liqui-tinic syrup instead. For pain management, we got prescribed Meloxicam 1.5mg/ml. What do you think about those medications?

Warmest regards,
Pretzel & Pretzel's Mom

Thanks for your update, P & PM! I'm glad that things went well with the Vet visit! The bandage will effectively act a splint and that should be quite satisfactory (assuming Pretzel will leave it alone!). IMHO and with my prior disclaimer, I agree completely with your Veterinarian's belief that Pretzel will recover and have a good quality of life!

As far as the medications that were prescribed; Torbutrol is a brand name for Butorphenol which is an opioid analgesic (pain reliever). I have never used this particular medications with Squirrels BUT but I am quite familiar with it and my not using it with Squirrel is not because I have any particular concerns about using it with Squirrels! It is most likely quite safe as this medication is found acceptable for "most species" of rodents and for Rats and Mice specifically by the Exotic Animal Formulary 5th Edition. It should be a very good pain reliever!

Meloxicam has an extensive use record with Squirrels and seems to me to be a very good choice! This medication is in the Non-steroidal anti-inflammatory drug family (NSAIDs) of medications and it too, should help with what I would suspect to be some significant discomfort that Pretzel is experiencing! I would recommend ensuring that he has had some food within an hour of your dosing of this medication.

I am not at all familiar with Liqui-tinic but I did look up this preparation on the internet. It is a Vitamin supplement that is marketed for a relatively large range of animals and sizes of animals including cattle, swine, horses, cats, dogs, kittens and puppies! Again, I do not want to get between you and your Vet but since you asked my opinion.... I am not not much in favor of these vitamin supplements in general. They are not regulated by the FDA or any entity and there is no obligation that they be supported by evidence of efficacy OR safety! If Pretzel is eating 2 Henrys Blocks and/or is eating quality Blocks such as Teklad (Envigo) or Mazuri Rat and Mouse Diet, he shouldn't need further vitamin supplementation. Ordinarily, if a medication is safe for little kittens, it may also prove to be safe for Squirrels but this is no hard and fast rule and more to the point; we really don't know its specific safety profile for kittens. The manufacturer simply states that this is made for the animals I listed above. Your Vet may have experience using this supplement with Squirrels or other rodents or little kittens. It may very well be quite safe but at least you have heard another side to its usage!

Please keep us updated on Pretzel's status and please post any further x-ray films.

What specifically did your new Vet feel was going on with Pretzel's right hind limb?

Regards,
SamtheSquirrel

[SamtheSquirrel2018]

Meloxicam has an extensive use record with Squirrels and seems to me to be a very good choice! This medication is in the Non-steroidal anti-inflammatory drug family (NSAIDs) of medications and it too, should help with what I would suspect to be some significant discomfort that Pretzel is experiencing! I would recommend ensuring that he has had some food within an hour of your dosing of this medication.
Regards,
SamtheSquirrel

Hi Pretzel's Mom:
I wanted to clarify my advice to regarding food and use of Meloxicam because my original advice was not clear. I should have stated specifically that you should ensure that Pretzel has had some food within an hour BEFORE using the Meloxicam!
Regards,

[SamtheSquirrel2018]

Hi Pretzel's Mom:
How is Pretzel doing?
Regards,
SamtheSquirrel

[pretzel's_mom]

Hi Pretzel's Mom:
How is Pretzel doing?
Regards,
SamtheSquirrel

Hello SamtheSquirrel,

I want to express my deep appreciation for your caring support.

The new vet didn't specifically note anything on the x-ray images, but allowed me to feel Pretzel's wiggly ankle and compare it to the non-injured one. Following your advice, I've been consistent in giving him medicine and ensuring he eats beforehand. Pretzel has been self-weaning for about two weeks and isn't too keen on the Henry's squirrel blocks I initially got for him. I'm planning to try the Mazuri Rat and Mouse Diet to see if he finds it more appealing. Currently, he's enjoying black walnuts, lettuce, pinecones, and other yard finds.

Despite my efforts to use a collar to prevent him from removing his bandage, Pretzel managed to free himself within 5 minutes, so I've resorted to adding more tape to secure the bandage.

Our vet visit this past Tuesday for a leg rebandaging revealed that Pretzel has gained more movement in his leg compared to before.

On the 21st, we have another appointment for a new set of x-rays and to remove Pretzel's bandage.

Once again, thank you all for your tremendous support. I'll be sure to keep you updated.

Best regards,
Pretzel & Pretzel's Mom.

[CritterMom]

Pretzel's Mom, please, PLEASE stop feeding him walnuts or any other nut on a daily basis. You are simultaneously providing a diet that is guaranteed to erode his bones away while trying to get a bone in his leg to heal. ALL nuts and pretty much ALL seeds are extremely high in phosphorus. Too much phosphorus that is not balanced by twice the amount of calcium is a one way ticket to metabolic bone disease. Think the worst osteoporosis you can have combined with an inability to contract your muscles and you have MBD.

He may eat the Mazuri but he is much, much better off dietarily with the Henry's. My guys prefer the hazelnut and the new walnut blocks. They are made with bits of nut which are properly balanced in the block. They should be the only nuts he is getting right now. This age is a difficult one - they get all sorts of calcium when they are on formula, but when they stop taking it they can suddenly find themselves getting the opposite of what they need nutritionally. It has become better known now, so more people avoid this pitfall, but when I started here at TSB in 2009, there were distinct "MBD seasons" which fell 12 to 18 weeks from the "baby season" that brought them in contact with humans in the first place. If you noted on a calendar when the people with new babies came here for help and counted forward, you would know pretty closely when the board would be deluged with paralyzed MBD babies. It was like terrible clockwork.

[SamtheSquirrel2018]

Hello SamtheSquirrel,

I want to express my deep appreciation for your caring support.

The new vet didn't specifically note anything on the x-ray images, but allowed me to feel Pretzel's wiggly ankle and compare it to the non-injured one. Following your advice, I've been consistent in giving him medicine and ensuring he eats beforehand. Pretzel has been self-weaning for about two weeks and isn't too keen on the Henry's squirrel blocks I initially got for him. I'm planning to try the Mazuri Rat and Mouse Diet to see if he finds it more appealing. Currently, he's enjoying black walnuts, lettuce, pinecones, and other yard finds.

Despite my efforts to use a collar to prevent him from removing his bandage, Pretzel managed to free himself within 5 minutes, so I've resorted to adding more tape to secure the bandage.

Our vet visit this past Tuesday for a leg rebandaging revealed that Pretzel has gained more movement in his leg compared to before.

On the 21st, we have another appointment for a new set of x-rays and to remove Pretzel's bandage.

Once again, thank you all for your tremendous support. I'll be sure to keep you updated.

Best regards,
Pretzel & Pretzel's Mom.

Thanks so much for the update! Please see CritterMom's post! This is presenting a major concern!!!
Regards,
SamtheSquirrel

[Diggie's Friend]

Henry's is the best block diet source currently available to support squirrels with whole foods added; as it is formulated at a higher ratio than that used in commercial rat block diets, yet without the unhealthy sources of cornmeal and soybean meal.

The good news for the nut loving squirrels is that HHB block, in all its variations, includes a specific measure of nuts, which are likewise factored with the other sources of phosphorus the block includes into the total Calcium and Phosphorus positive ratio. And though there are other foods that have even higher ratios of P:Ca than walnuts, hazelnuts, and pecans do; it is the adding of nuts to this or any other diet that has been found to be the source that breaks the proverbial camel's back as far as tipping the Ca:P to, too close to equal or past that to becoming inverted which promote the development of Metabolic Bone Disease.