ORTHOPEDICS 1094–9194/02 $15.00
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FERRET ORTHOPEDICS
Tracey K. Ritzman, DVM and David Knapp, DVM, Dipl ACVS

Because of the growing popularity of the ferret as a companion

animal, the number in captivity continues to increase. In clinical practice,
veterinarians are likely to encounter an orthopedic abnormality in the
ferret patient that requires surgical intervention. The ferret’s compact,
tubular body shape, inquisitive personality, and natural burrowing be-
havior predisposes it to orthopedic injuries. These injuries often occur
secondary to accidental trauma, such as being stepped on or getting
trapped in a confined space or caging. The surgical principles used in
canine and feline orthopedics (e.g., joint approaches, techniques for
reduction and stabilization) can be applied to the ferret patient with
minor modifications for differences in body size. This article presents an
overview of the clinical signs, diagnosis, surgical treatment options, and
postoperative care of orthopedic conditions in the ferret.

PHYSICAL EXAMINATION

A complete physical examination aids the clinician in diagnosing

orthopedic conditions of the ferret patient. Often, physical examination
alone is adequate to identify the location of the orthopedic abnormality.
At the time of initial presentation, the clinician should obtain a thorough
anamnesis. A ferret with a history of thoracic or abdominal trauma that
presents with clinical signs of shock, hemorrhage, respiratory distress,
or abdominal enlargement requires immediate evaluation because of the
potential for emergent disease such as pneumothorax or hemoabdomen.
After the patient has been stabilized, complete physical and neurologic

From the Avian and Exotic Pet Medicine Service (TKR); and the Department of Surgery
(DK), Angell Memorial Animal Hospital, Boston, Massachusetts

VETERINARY CLINICS OF NORTH AMERICA:

EXOTIC ANIMAL PRACTICE

VOLUME 5 • NUMBER 1 • JANUARY 2002 129

130 RITZMAN & KNAPP

evaluations can be performed. Orthopedic conditions are not considered

an emergency unless the ferret has spinal trauma or fractures that may
lead to paralysis if surgical care is not provided immediately. Most
ferrets with orthopedic injuries present with nonemergent conditions
and can tolerate the restraint required for a thorough initial physical
examination and diagnostic procedures.
Indications of trauma in the ferret patient include skin abrasions or
bruising, soft tissue wounds or swelling, and limb fractures with or
without bone displacement. Joint luxation or subluxation, hemorrhage,
and abdominal enlargement secondary to hemorrhage also can occur. A
non–weight-bearing lameness is common in the affected limb. An oral
examination should be performed to evaluate the teeth, maxilla, and
mandible of the ferret. The clinician may note fractures of the tips or the
body of the canine teeth, which may be an indication of a traumatic
event or excessive chewing by the ferret. The ferret patient that experi-
ences muscular, skeletal, or abdominal discomfort may exhibit bruxism
during the examination.
The skeleton and musculature of the ferret is similar to that of the
dog, with only minor differences. The vertebral formula of the ferret is
C7, T14-15, L5-7, S3, Cd18.5 The vertebral column of the ferret is flexible,
and the vertebrae are large in relation to the size of the ferret’s body.3, 5
The ferret’s thoracic and pelvic limbs are similar to that of the dog, with
the one exception being that the ferret has two sesamoids associated
with the first digit instead of the dog’s one. The musculature of the
ferret is similar to that of the canine and feline species, with some minor
differences in the limb attachments. In the ferret, the clavicle is quite
small and the thoracic limb is attached to the scapula at the shoulder
joint only by muscles.5 The rear limb of the ferret is attached to the
pelvis at the coxofemoral joint. The stifle joint in ferrets is similar in
structure to that of the stifle joint in dogs.
During the physical examination, the ferret’s gait should be evalu-
ated. The ferret normally stands plantigrade, with its body weight sup-
ported by the carpal and tarsal bones and the five digits of each foot.
The normal ferret ambulates with a strong, regular gait. Hind-limb
musculoskeletal weakness is a common clinical presentation in the ferret
patient and often is associated with systemic illness, such as hypoglyce-
mia, rather than with a primary musculoskeletal problem or myelopathy.
The neurologic evaluation is similar to that for other species. With-
drawals and conscious pain perception are evaluated as they are for dogs
and cats. Hopping and placement reactions may be used for evaluating
conscious proprioception. Tendon reflexes should be assessed for ferrets
that are suspected of having a myelopathy or peripheral neuropathy.
Posterior paresis or paralysis accompanied by incontinence may appear
in a ferret secondary to spinal trauma or spinal disease.11 Electromyogra-
phy is used in the authors’ practice for evaluating the electrical activity
in the skeletal muscles of ferret patients that present with limb paresis
or other neurologic symptoms. This diagnostic modality, if available,
 FERRET ORTHOPEDICS 131

is useful in assessing nerve-conduction potentials of the limbs. For

postoperative evaluation of nerve conduction, results are not considered
reliable until approximately 7 days after the surgical procedure.2

RADIOGRAPHY

Radiography is an indispensable tool for confirming a diagnosis

and for classifying an orthopedic injury. The use of radiography allows
for thorough evaluation of the injury, is instrumental in selecting the
optimal treatment protocol, and provides reference images for postoper-
ative comparison. In the authors’ hospital, ferrets with a history of
trauma receive two views that incorporate the whole body, including
the limbs. Whole-body radiographs allow for the evaluation of thoracic
and abdominal structures in addition to the appendicular skeleton. With
distal extremity injuries, at least two images—usually a lateral and
cranial-caudal view specific to the affected limb or joint—are obtained.
High-detail radiographic film or mammography film provides excellent
detail for these small patients. Radiographs of the opposite (unaffected)
limb are useful for comparison and determination of normal versus
abnormal anatomy. Most ferrets require either sedation or brief anesthe-
sia for optimal radiographic positioning.

ORTHOPEDIC CONDITIONS

Table 1 summarizes a 3-year retrospective survey of the number

and type of ferret orthopedic conditions treated at the authors’ practice.
Orthopedic injuries are relatively uncommon in the ferret compared
with other medical conditions, such as gastrointestinal, cardiac, endo-
crine, and neoplastic disease. Congenital or developmental orthopedic
abnormalities, such as limb deformities, are not well documented in
the ferret.

Traumatic Fractures

The most common cause of orthopedic injury and conditions that

require surgical intervention in the ferret patient involve traumatic injury
to the long bones, joints, or spine. These injuries often occur secondary
to accidental trauma, such as being stepped on or getting caught in a
confined space. Traumatic fractures secondary to a long fall (high-rise
syndrome) are also a common orthopedic injury in the ferret. One case
of a ferret that had been hit by a car was documented at the authors’
practice; severe soft tissue swelling of the head and neck and pulmonary
contusions were seen, but there were surprisingly no fractures. The most
common fracture sites include the humerus, radius and ulna, femur, and
132 RITZMAN & KNAPP

Table 1. RETROSPECTIVE SURVEY OF 17 FERRET ORTHOPEDIC CASES

Orthopedic Condition Number Treatment Options Used

Bilateral elbow luxation 2 Transarticular intramedullary

Unilateral elbow luxation
Fracture of the humerus
Fracture of the proximal ulna (olecranon)
Unilateral fracture of the femur
Bilateral fracture of the femur
Fracture of the tibia and fibula
Stifle injury (cranial cruciate rupture)
Vertebral (T5) mass
pins and type I external
skeletal fixators plus external
bandage
4 Transarticular intramedullary
pin from humerus into
proximal ulna or radius; cross
pins
2 Intramedullary pin tied into
type I external skeletal fixator
1 Intramedullary pin within ulna
plus figure-eight cerclage wire
3 Intramedullary pin, modified
type I external skeletal fixator,
and cerclage wires; K-wires in
cross pin fashion
2 Intramedullary pins and an
external skeletal fixator
1 Intramedullary pin incorporated
into an external skeletal
fixator
1 No surgical treatment required;
cage rest
1 Further diagnostics and
treatment declined

Data from Angell Memorial Animal Hospital, Avian and Exotic Pet Medicine Service, Boston,
Massachusetts.

tibia and fibula. Femoral neck fractures have not been noted in Table 1,
but this fracture type has been documented in one ferret.13

Fractures of the Thoracic Limb

Fractures of the Humerus

Humeral fractures in the ferret patient usually are traumatic in
origin. Clinical signs of a fracture of the humerus include a non–weight-
bearing lameness of the affected limb. The ferret usually holds the
affected leg with the elbow dropped and with the paw resting on its
dorsal surface because of a weakening of the muscles involved with
limb extension.2 The ferret also may have soft tissue bruising or swelling
of the affected limb.
Fractures of the humerus are treated most optimally by internal
fixation in the ferret. Treatment with external coaptation alone usually
is unrewarding and can lead to malunion because of the difficulty in
immobilizing the shoulder joint. Internal fracture fixation of the humerus
in the ferret is similar to techniques used in other domestic mammals.
 FERRET ORTHOPEDICS 133

Stainless steel intramedulary pins, orthopedic wire, bone plates, or exter-

nal skeletal fixation can be used for repair of the humerus. The type
of internal fixation is based on the location and configuration of the
fracture.
A 2-year-old ferret presented to the authors’ practice with a closed,
comminuted, long oblique fracture with a long butterfly fragment of the
humerus secondary to a traumatic event. Open reduction and internal
fixation were performed using an intramedullary pin tied into a four-
pin, type I, lateral, external skeletal fixator with an acrylic connecting
bar. The ferret was cage rested for 2 months. Eight weeks after surgical
stabilization, repeat radiographs revealed complete healing of the frac-
ture site. The external fixator was removed under brief anesthesia and
this ferret patient returned to normal activity and use of the limb.

Fractures of the Radius and Ulna

External coaptation may be applicable to some fractures of the
radius and ulna, especially if only one of the bones is fractured, because
the intact bone can serve as a natural splint and can prevent overriding
or significant displacement of the fractured bone. Stabilization using
external coaptation requires immobilization of the elbow joint as well as
the carpus. Injuries with severe distraction of one bone may require
internal fixation to prevent synostosis from occurring. Comminuted or
displaced fractures of the radius and ulna usually require internal fixa-
tion.2, 10, 11 The use of open surgical reduction and repair with intramedul-
lary pins, orthopedic wire, or an external skeletal fixator is based on the
type of fracture. A padded bandage may be indicated in cases without an
external skeletal fixator to prevent postoperative swelling and overuse of
the limb. Cage rest and confinement is required after surgery, and
radiographic evaluation of the fracture site is recommended 4 to 5
weeks after surgery to evaluate bone healing. The timing of the repeat
radiographs depends on the location of the fracture, the type of fracture,
and the age of the ferret.

Fractures of the Proximal Ulna (Olecranon)

Fractures of the proximal ulna that involve the olecranon have been
documented in the ferret but are an uncommon presentation. Only one
case of a proximal ulnar fracture has been documented in Table 1. In
this case, a unilateral olecranon fracture occurred secondary to a trau-
matic fall down a spiral staircase in the home (Fig. 1). The ferret was
rendered lame immediately but could bear some weight on the affected
forelimb, with minimal soft tissue swelling. Successful repair of the
proximal ulnar fracture was performed via open surgical reduction by
placing a single small-gauge Kirschner (k-) wire through the olecranon
into the distal ulna along with a figure-eight wire (Figs. 2, 3, and 4). A
padded bandage that extended to the axillary area was applied to the
limb after surgery (Fig. 5) and was removed 1 week later. After bandage
134 RITZMAN & KNAPP

Figure 1. Radiograph of an adult, male ferret with forelimb lameness after a traumatic fall.
A right olecranon fracture with proximal displacement and soft tissue swelling is present.

Figure 2. Intraoperative view of right olecranon reduction and stabilization. A stainless

steel pin is being used to drill a transverse hole in the proximal ulna for placement of the
figure-eight wire.
 FERRET ORTHOPEDICS 135

Figure 3. Postoperative lateral radiograph of the right elbow joint after surgical reduction
of a right olecranon fracture. This fracture has been aligned and stabilized by means of a
single K-wire placed through the olecranon into the distal ulna along with a figure-eight wire.

removal, passive physical therapy was provided at home with gentle

flexion and extension of the elbow joint for a few minutes several times
a day with continued cage rest.

Carpal and Digit Injuries

Carpal bone fractures or joint luxations rarely are diagnosed in
ferret patients; however, the potential for these injuries exists. In ferrets
and dog, these injuries occur from trauma to the carpus or foot. Total
luxation of the antebrachiocarpal joint is a rare injury in the dog and
cat.2, 11 The most common injured ligaments of the carpal joint of the
dog are the radial collaterals, resulting in medial instability and a lateral
(valgus) deformity of the foot.2, 11 Surgical treatment for carpal or digit
injuries is similar to the techniques used in the canine or feline patient.
136 RITZMAN & KNAPP

Figure 4. Cranial-caudal radiographic view of the reduced and stabilized right olecranon
fracture in the ferret. The fracture has been aligned and stabilized by means of a single K-
wire placed through the olecranon into the distal ulna along with a figure-eight wire.

Fractures of the Pelvic Limb

Fractures of the Femur

Of the many types of long bone fractures, fracture of the femur is
one of the most common orthopedic injuries seen in the ferret and
usually is the result of trauma (Figs. 6 and 7). As with fractures of the
humerus, fractures of the femur usually are not amenable to treatment
with external coaptation alone. If external coaptation is to be used, a
Spica-type splint needs to be used to immobilize the coxofemoral joint.
In ferrets, placing and maintaining a Spica splint is difficult owing to
their short limb length, active nature, and interest in chewing splint
materials. For a distal femoral fracture, a Schroeder–Thomas splint may
be appropriate for stabilization.
Internal fixation of femur fractures is the treatment of choice in
most cases. An external skeletal fixator can be used with or without
 FERRET ORTHOPEDICS 137

Figure 5. A ferret after internal reduction and stabilization of a right olecranon fracture. A
soft, padded bandage has been applied to the limb for support during the immediate
postoperative period.

Figure 6. Lateral radiograph of an adult female ferret with a history of trauma to the caudal
body. A fracture of the distal left femur is visible. There is severe soft tissue swelling
surrounding the area. Linear lucencies in the distal femur indicate possible intercondylar
fracture as well as the fracture of the distal metaphysis.
138 RITZMAN & KNAPP

Figure 7. Cranial-caudal radiograph of an adult female ferret with a history of trauma to

the caudal body. A fracture of the distal left femur is visible.

intramedullary pin support. A type I external skeletal fixator usually is

used on the femur. Type II and III external skeletal fixators can cause
damage to the body medial to the leg and can be uncomfortable for the
ferret. If additional stability is required beyond a single type I fixator, a
biplanar configuration (two type I fixators at 90 angles) can be placed
on the femur. More bone is required for additional pin placement when
using the biplanar configuration compared with a single external skeletal
fixator. Polymethylmethacrylate or another form of acrylic can be used
to unite the fixation pins. This material usually is resistant to any
chewing action by the ferret.
A 3-month-old ferret presented to the authors’ practice with bilateral
diaphyseal femoral fractures after falling 20 feet from a balcony. For
surgical repair, bilateral lateral approaches were made to each fractured
femoral diaphysis. The femoral shafts were exposed and visualized and
intramedullary pins were retrograded proximally, reducing the fractures
when the pins were set after a normograde placement. A three-layer
closure was performed using 4-0 absorbable sutures, and skin closure
 FERRET ORTHOPEDICS 139

was performed with tissue adhesive. Postoperative radiographs con-

firmed good reduction and alignment of the femoral fractures using the
intramedullary pin technique (Fig. 8). Management for this ferret in-
cluded strict cage confinement at home for 5 weeks. The intramedullary
pins were not removed, and this ferret had a complete return to normal
function of the rear limbs after healing.
In another ferret patient seen in the authors’ clinic, a right femoral
fracture occurred secondary to being stepped on accidentally in the
home. This fracture was repaired surgically by placing an intramedullary
pin and a modified type I external fixator. Two full cerclage wires were
placed in the mid-diaphyseal region to provide additional reduction and
rotational stability (Fig. 9).
Occasionally, an orthopedic injury that affects the femur may not
respond to surgical repair. A ferret patient may present with a severe
injury to the hind limb, resulting in a comminuted or open femoral
fracture. A 5-month-old ferret presented to the authors’ practice with a
comminuted, closed fracture of the distal left femur after a fall onto a

Figure 8. Postoperative radiograph of a 3-month-old ferret after internal surgical reduction

of a distal femoral fracture. The distal femoral fracture has been reduced and is held in
alignment using two small intramedullary pins. The shorter pin exits the caudal cortex
shortly after engaging the proximal fragment.
140 RITZMAN & KNAPP

Figure 9. Postoperative lateral radiograph of a 4-year-old female ferret after internal

reduction and stabilization of a right femoral fracture. The fracture has been reduced and
stabilized with an intramedullary pin and a modified type-I external fixator. Two full cerclage
wires have been placed in the mid-diaphyseal region to provide additional rotational stability.

concrete surface from a three-story window. Radiographs of the limb

confirmed a fracture of the distal metaphysis of the left femur, with
intercondylar involvement and fracture. Surgical exploration of the frac-
ture site was performed. A lateral parapatellar incision was made at the
left stifle, and the joint was entered to assess the fracture. A distal
femoral fracture was noted, consisting of four pieces: lateral condylar,
medial condylar, a butterfly medial segment, and a large proximal seg-
ment. This injury was determined to be nonrepairable, and the joint
capsule was closed. This ferret was managed with analgesia, external
coaptation, and strict cage rest for 6 weeks. Unfortunately, this patient
was lost to follow-up, so the outcome of this injury is not known.

Fractures of the Tibia and Fibula

Fractures of the hind limb that involve the tibia or fibula usually
are caused by a traumatic event. In most cases, rigid internal fixation is
recommended for reduction and stabilization of the fracture. Internal
fixation offers many advantages, including better stabilization of the
fracture and the ability of the ferret to use the joints above and below
the fracture site. Conservative therapy using external coaptation, such
as a modified Thomas splint, may be acceptable in some cases. Again, if
splinting is the method of treatment, the joints above and below the
fracture site need to be immobilized. In ferrets, it is common for both
the tibia and the fibula to become fractured owing to the ferret’s small
body size and relatively short limbs.
 FERRET ORTHOPEDICS 141

Internal fixation with intramedullary pin placement and a type I or

II external fixator is acceptable in most ferret patients. The external
skeletal fixator, if applied, usually is placed on the medial aspect of the
limb. If both the tibia and the fibula are fractured, reduction and align-
ment of the tibia usually brings the fibula into alignment as well. As
with canine and feline fibular fractures, the fibula usually does not need
to be stabilized separately and heals after the tibia is repaired.
An example of a closed hind-limb fracture of the tibia and fibula
seen in the authors’ practice is shown in Figures 10 and 11. These
radiographs are from a two-and-a-half-year-old ferret that was found
suddenly lame within its cage. Physical examination revealed a non–
weightbearing lameness of the left hind limb and crepitus on palpation
in the area of the tibia and fibula. The radiographs confirmed the
fractures of the left tibia and fibula. Surgical repair was performed on
the limb using an intramedullary pin tied into a type I external skeletal
fixator. A medial approach to the midshaft of the tibia was made. An
intramedullary pin was placed normograde into the tibia after the frac-

Figure 10. Lateral radiograph of a 2.5-year-old ferret that was found suddenly lame within
its cage. Fractures of both the tibia and fibula are present.
142 RITZMAN & KNAPP

Figure 11. Cranial-caudal radiograph of ferret shown in Figure 10.

ture was reduced manually. Four cross pins were placed through the
tibia above and below the fracture site, and a type II acrylic K-E device
was placed with the intramedullary pin tied into it medially. A two-
layer subcuticular closure was performed using 5-0 absorbable sutures,
and tissue adhesive was used for the skin closure. Postoperative radio-
graphs showed that the tibial fracture ends had been brought into
excellent apposition and alignment. Repair of the tibial fracture had
brought the fibular fracture ends into alignment as well (Figs. 12 and
13). This patient was prescribed cage rest after surgery, and the implants
were removed 6 weeks later after radiographic confirmation of adequate
healing. A return to normal function of the limb was achieved.

Metatarsal and Tarsal Injuries

Many tarsal or metatarsal injuries in the canine patient often are

caused by overstress of the ligamentous structures or are related to a
history of trauma.10, 11 Although metatarsal and tarsal injuries are not
 FERRET ORTHOPEDICS 143

Figure 12. Postoperative lateral radiograph of tibial fracture repair of ferret shown in Figure
10. The tibial fracture has been repaired using a combination of intramedullary pin and
external fixator. The intramedullary pin has been incorporated into the external skeletal
fixator device. Fracture ends are in excellent apposition and alignment. Repair of the tibial
fracture has brought the fibular fracture ends into alignment as well.

common in ferrets and have not been listed in Table 1, injuries of this
type can occur. Treatment in the ferret is similar to that used in other
domestic mammal species.

Elbow Luxations

Elbow luxations are a common condition in ferrets. Patients usually

present with a non–weight-bearing lameness of the forelimb and a
swollen and painful elbow joint. Elbow luxations can occur spontane-
ously or secondary to traumatic insult and can involve either a medial
or lateral displacement of the limb distal to the elbow joint. Radiography
that includes two views of the limb provides confirmation of the luxation
and assists the clinician with treatment decisions (Figs. 14 and 15).
144 RITZMAN & KNAPP

Figure 13. Postoperative cranial-caudal radiograph of a tibial fracture repair. The tibial
fracture has been repaired using a combination of intramedullary pin and external fixator.
The intramedullary pin has been incorporated into the external skeletal fixator device.
Fracture ends are in excellent apposition and alignment. Repair of the tibial fracture has
brought the fibular fracture ends into alignment as well.

Treatment for elbow luxation involves reduction and stabilization

of the joint.1 In some ferrets, closed reduction can be performed under
sedation or anesthesia; however, recurrence is common with closed
reduction and external coaptation alone. This type of external coaptation
usually includes a padded bandage applied up to the axillary area.
Occasionally, the ferret can be anesthetized, and reduction of the joint
can be performed in a closed procedure, and the limb can be immobi-
lized with a Spica-type splint. The goal of this type of splint placement
is to immobilize the scapulohumeral joint because easily reducible elbow
joints often reluxate. In the authors’ experience, the most effective form
of treatment for elbow luxation in the ferret includes internal fixation
and an external bandage after surgical stabilization to prevent overuse
of the limb, which could lead to implant breakdown.
Surgical reduction and internal stabilization of the elbow joint is
 FERRET ORTHOPEDICS 145

Figure 14. Lateral radiograph of a ferret with a left elbow joint luxation.

performed most optimally in most cases with an open surgical ap-

proach,1 which allows for direct visualization of the bony structures and
precise placement of the surgical implants. Occasionally, the elbow-joint
stabilization can be performed via a closed technique,1 which has the
advantage of being less invasive but the disadvantage of not being able
to visualize the bones of the joint directly during implant placement.
A lateral approach is used for access to the elbow joint in the ferret.
The surgical technique involves making a lateral incision over the elbow
joint. The elbow luxation is reduced manually, and then internal stabili-
zation is performed using a combination of intramedullary pins, stain-
less steel wire, or an external skeletal fixator. In many cases, effective
stabilization was achieved by placing a transarticular intramedullary pin
tied into a type I transarticular acrylic fixator (Fig. 16). When placing a
transarticular pin, the elbow should be placed in 100 to 110 flexion,
which maintains functional limb length and achieves optimal purchase
of the proximal ulna with the pin.
In a ferret patient that presented to the authors’ practice with
bilateral elbow luxation secondary to a traumatic fall (Fig. 17), both
146 RITZMAN & KNAPP

Figure 15. Cranial-caudal radiograph of a ferret with a left elbow joint luxation.

elbow joints were reduced and stabilized via an open surgical technique.
In this ferret, lateral approaches were used in both elbow joints and the
elbow luxations were reduced manually. A K-wire was placed normo-
grade down the humerus to stabilize the luxation and was seated in a
transarticular fashion into the proximal ulna. K-wires were placed on
the distal humerus and the proximal radius and were incorporated into
a lateral, type I external acrylic fixator on both elbows. Closure was
routine in a two-layer fashion with a 5-0 monofilament, absorbable
suture. This ferret patient did well after surgery with the bilateral exter-
nal fixators to stabilize the elbow joints. A radiographic evaluation of
both elbows was performed 3 weeks after the surgical stabilization. One
of the elbow joints in this patient developed progressive osteolysis in
the bones of the right elbow. The progressive erosion of the articular
surfaces of the right elbow was thought to be secondary to the trauma
that the joint experienced or to potential septic arthritis. Antimicrobial
therapy was initiated in this patient because of the potential for infection,
and the ferret continued to convalesce with both elbows remaining in
 FERRET ORTHOPEDICS 147

Figure 16. Left elbow luxation reduction and stabilization in a ferret, using a transarticular
intramedullary humeral pin tied into a modified K-E apparatus.

reduction. Radiographic evaluation 4 weeks after the surgical procedure

showed increased bone loss in the proximal radius and ulna, with
remodeling of the distal humerus. Both elbows remained in reduction,
and the external fixators were removed 3 weeks after placement. Antimi-
crobial therapy was continued for 4 weeks. Physical therapy of both
elbow joints occurred at home by having the owner gently flex and
extend the joints for 5 minutes several times daily. The ferret experienced
good return of function of both elbow joints, and a recent evaluation
revealed only mild crepitus in the right elbow joint and an acceptable
range of motion.
Posttraumatic osteomyelitis is a potential complication of fractures
of ferrets, rabbits, and small rodents8 and occurs secondary to the incit-
ing trauma to the joint and bones, to bone avascularity, or to wound
contamination with secondary postoperative infection. Ferrets with post-
operative osteomyelitis have clinical signs and pathology that are similar
to that of dogs and cats. Treatment of postoperative osteomyelitis and
the use of drainage systems are similar to that of other companion
148 RITZMAN & KNAPP

Figure 17. Lateral radiograph of a ferret with bilateral elbow luxation secondary to a
traumatic fall. Both elbow joints were reduced and stabilized via open surgical technique
using an intramedullary pin in each humerus and intramedullary pins in the distal humerus
and proximal ulna of each elbow tied into a type I external skeletal fixator.

animal species. If possible, samples should be collected for aerobic and

anaerobic bacterial cultures, and antibiotics should be administered
based on the culture results and sensitivity testing. Treatment of postop-
erative osteomyelitis often is successful in ferrets, whereas it is usually
unsuccessful in rabbits, requiring amputation of the affected limb.8 When
working with contaminated wounds, good hemostasis, careful wound
handling, adherence to strict sterile surgical techniques, and anatomic
closure all help reduce the risk of posttraumatic osteomyelitis.8

Limb Amputation

Amputation of a limb is indicated only when the orthopedic injury

is too severe to salvage the limb or when financial constraints of the
owner limit the ability to pursue surgical repair with the necessary
 FERRET ORTHOPEDICS 149

follow-up bandage changes and radiography. Amputation of a limb also

may be necessary when the treatment of severe posttraumatic osteomy-
elitis is unsuccessful.8 This procedure should be considered in ferret
patients with primary bone neoplasia.
Ferrets can adapt to the amputation of a single limb, and most
ambulate well on three limbs. The level of amputation chosen depends
on where the injury has occurred. The surgical approach to limb amputa-
tion in the ferret is similar to that in other domestic animals. Most
amputations of the forelimb in the ferret are performed by removing the
scapula and limb. Removing the thoracic limb at the scapulohumeral
joint in ferrets is also feasible; the thoracic limb of the ferret is attached
to the scapula at the shoulder joint only by muscle attachments. For
pelvic limb amputations, the mid-femoral procedure is recommended
because it is more cosmetic in ferrets.8 The pelvic limb has to be disarticu-
lated and amputated at the coxofemoral joint with a proximal femoral
injury or infection close to the joint.8
Analgesic support (see section on Analgesia) and cage rest is neces-
sary after amputation until the surgical site heals.

Spinal Injury

Vertebral injuries, including spinal fractures, are seen on occasion

in the ferret, and usually are secondary to a traumatic event such as a
fall. As mentioned previously, hind-limb weakness that mimics hind-
limb paresis is a common clinical syndrome in ferrets with hypoglycemia
or other systemic illness.7 A ferret that presents with signs of hind-limb
paresis or paralysis should have a thorough orthopedic and neurologic
examination as well as a routine bloodwork evaluation to sort out the
cause of the hind-limb symptoms. Ferrets with spinal trauma or disease
have physical exam findings that are consistent with posterior paralysis
accompanied by incontinence. Posterior paralysis in the ferret can have
several different causes, including hemivertebrae, vertebral fractures,
intervertebral disc disease, hematomylia associated with prolonged es-
trus, neoplasia, myelitis caused by fungal infection, and rabies.4, 9
Neoplasia of the spinal column has been documented in ferrets (see
section on Neoplasia of the Skeletal System) and can result in a sudden
onset of hind-limb paresis or paralysis, which the owner may think was
caused by a traumatic event. Radiography (Fig. 18) and myelography
are instrumental in diagnosing spinal disease. The long-term prognosis
is guarded if there is severe spinal cord damage.

Neoplasia of the Skeletal System

Musculoskeletal neoplasms are the sixth most frequently reported

group of tumors in the ferret.9 Chordomas are the most common type of
musculoskeletal neoplasia reported in the ferret, and the most frequent
150 RITZMAN & KNAPP

Figure 18. Lateral radiograph of an adult male ferret with acute onset of hind limb paresis.
There is a mass effect seen between the fourth and sixth thoracic vertebrae dorsal to the
vertebral canal. There is extensive lysis of the dorsal spinal process of T5 as well as the
vertebral laminae. A primary neoplastic process was suspected from the radiograph.

location for chordoma formation is on the tail; however, these are slow-
growing neoplasms and typically do not metastasize. Cervical spine
chordomas are uncommon, but several cases have been documented in
the ferret. Cervical chordomas may induce osteolytic reaction of the
vertebra and can compress the spinal cord or adjacent tissues.9 Osteomas,
chondromas, chondrosarcomas, fibrosarcomas, rhabdomyosarcomas, and
synovial cell sarcomas are all primary neoplasms of the musculoskeletal
system documented in the ferret.9
Neoplasia of the spine has been documented in ferrets as causing
hind limb paresis or paralysis.4, 9 Metastatic lymphoma to the vertebrae
can cause osteolytic lesions.9 A case of spontaneous plasma cell myeloma
that involved the lumbar vertebrae in a ferret with paraparesis has been
reported in the literature.9 Acute myelogenous leukemia was diagnosed
in a 1-year old ferret with nonsupporting lameness of the forelimb. A
cystic bone lesion in the proximal humerus was radiographically visible.
At necropsy, acute myelogenous leukemia was diagnosed in the hu-
merus and the thoracic vertebra.9 Figure 18 is a lateral radiograph of a
2-year-old ferret with a history of acute onset of hind-limb paresis and
urinary incontinence. Whole-body radiographs revealed an expansile
mass effect seen between the fourth and sixth thoracic vertebrae dorsal
to the vertebral canal. Extensive lysis of the dorsal spinal process of T5
and the vertebral laminae was visible. A primary neoplastic process was
suspected from the radiograph but was not confirmed in this patient.

Maxillary and Mandibular Fractures

Maxillary and or mandibular fractures can occur secondary to

trauma or primary bone disease. The treatment for fractures of the upper
or lower jaw is similar to that used in the feline patient.
 FERRET ORTHOPEDICS 151

Stifle Injury

Although the stifle joint anatomy of the ferret is similar to that of

other companion animals, the occurrence of stifle joint injury in ferrets
is low.5 This low occurrence of stifle injury is because of the ferret’s
small, relatively compact body size and short pelvic limb length. Cruci-
ate ligament ruptures are not documented in the literature, but treatment
would be similar to that used in canines. One case of stifle injury was
documented in the authors’ practice: a ferret with unilateral hind-limb
lameness. Orthopedic examination revealed a positive anterior drawer
sign that indicated a cruciate ligament injury. Surgical therapy was not
required with this patient because the ferret had acceptable use of
the limb. As evidenced in the feline patient, conservative management
(restricted activity) and the administration of a nonsteroidal anti-
inflammatory drug resulted in a high percentage of cats returning to
normal function. Cage rest was prescribed, and the ferret did well with
this conservative therapy.

Nutritional Disease

Inadequate or inappropriate nutrition can contribute to skeletal

disease, which can predispose the ferret to skeletal deformities and
fractures. Inadequate dietary levels of protein, fat, and calcium can lead
to the development of metabolic bone disease. A ferret fed only a red-
meat diet could be at increased risk for developing nutritional disease.
A thorough dietary history should be obtained when evaluating a ferret
patient with skeletal deformities or fractures. A calcium-to-phosphorus
ratio of 1.2:1 to 1.7:1 is found in commercial ferret food formulations.6
For ferrets, the minimum required calcium and phosphorus levels are in
the range of 0.4% to 1.0% calcium and 0.4% to 0.8% phosphorus, pro-
vided that adequate vitamin D is present.6 Diets that are too high in
calcium and too low in vitamin D and phosphorus can lead to skeletal
abnormalities characterized by enlargement of the bones or difficulty
ambulating.6 Renal impairment also has been documented in relation to
high levels of calcium and vitamin D in the diet. Tetany, convulsions,
and spontaneous fractures have been associated with inadequate levels
of dietary calcium.6 Low phosphorus levels in the diet have been associ-
ated with slowed growth, poor appetite, and osteomalacia in adult
ferrets.6 Nutritional hyperparathyroidism has been documented in the
ferret and is associated with an all-meat diet with no calcium supplemen-
tation.6 Although not commonly seen in pet ferrets owing to the avail-
ability of high-quality commercial ferret diets, this condition has been
documented in several ferret farms in New Zealand.6 Clinical signs
include weight loss, reluctance to move or support body weight, and
abnormal posturing, including abduction of the forelimbs. The bones are
soft and pliable, and fractures are often present.6 Pathologic findings
include soft, rubbery bones and the parathyroid glands are usually
152 RITZMAN & KNAPP

hyperplastic. The microscopic bone structure of affected ferrets appears

osteoporotic with lesions typical of osteodystrophia fibrosa.6 To prevent
this condition, a high-quality commercial ferret food should be used. If
natural products such as an all-meat diet are used, the diet should be
supplemented with 5% to 10% ground bone or fortified with 2% bone
meal or 2% dicalcium phosphate.6 Calcium and phosphorus levels can
be evaluated on a serum or plasma chemistry analysis. The optimal ratio
of calcium to phosphorus in the ferret is the same as that for other
mammals, with a 2:1 calcium to phosphorus ratio being optimal.6 Young
growing ferrets may have a higher than normal phosphorus level.

PREOPERATIVE CONSIDERATIONS

The orthopedic ferret patient should be evaluated thoroughly for

evidence of other preexisting disease conditions that may contribute to
anesthetic or surgical morbidity or mortality. A minimum diagnostic
database, including a packed cell volume, total protein level, estimated
complete blood cell count, and plasma glucose level, and hepatic and
renal assessments should be obtained before scheduling surgery. Because
of the high incidence of medical problems in ferrets aged over 3 years,
including occult cardiac disease, hypoglycemia, and neoplasia, a thor-
ough preoperative assessment is indicated. Ferrets aged 3 years or older
should have a complete blood cell count and plasma biochemical analy-
sis performed yearly to screen for occult disease. When radiographs are
performed, evaluate the thoracic structures, including cardiac size and
shape and the lung fields, before considering anesthesia. Ferrets with
cardiac disease or hypoglycemia may require further diagnostic evalua-
tion or medical therapy before the orthopedic surgery.

Anesthesia

Anesthesia for ferrets is similar to that for felines. Most ferret pa-
tients can be induced in an enclosed chamber with an appropriate gas
anesthetic. Most ferrets tolerate chamber induction better than active
restraint with facemask application. Intubation is recommended for di-
rect airway access and control of respiration. A laryngoscope with a
pediatric blade facilitates visualization of the larynx. A 2- to 3.5-mm
internal-diameter cuffed endotracheal tube will fit most ferrets.4a Ferrets
have a high level of jaw tone, and a proper level of muscular relaxation
is required for intubation.4a For the healthy orthopedic ferret patient
without other medical illnesses, anesthesia may include induction and
maintenance with an inhalant anesthetic such as Isoflurane.4a Monitoring
can be performed with electrocardiography or pulse oximeter. The reader
is referred to the current literature on this subject for additional informa-
tion.4a
 FERRET ORTHOPEDICS 153

Analgesia

As a component of postoperative management, analgesia should be

given to all ferret patients recovering from orthopedic surgery. Clinical
signs of pain or discomfort in the ferret include vocalization, anorexia,
lethargy, reluctance to move or curl into a normal sleeping position, and
squinting.3, 7 In the authors’ practice, analgesia is provided routinely in
the form of a long-acting opioid, buprenorphine 0.01 to 0.03 mg/kg
intramuscularly or intravenously every 8 to 12 hours. Other analgesic
agents appropriate for use in the ferret include butorphanol or carprofen.
Nonsteroidal anti-inflammatory medications should be used with cau-
tion in ferrets with enteritis or gastritis.

POSTOPERATIVE MANAGEMENT
AND PATIENT FOLLOW-UP

One of the primary goals of the veterinary clinician regarding post-

operative care should be pain management immediately after surgery
and prevention of overactivity or excessive strain on the surgical repair
site or implants. Because of their highly active nature and normally
vigorous activity level, ferret patients can be a challenge to manage
during the postoperative period. The goals of postoperative bandaging
is to maximize patient comfort level and to minimize strain on the
implants to allow for proper healing. If there are open wounds related
to the injury, then daily bandage changes may be required. Bandaging
also reduces the amount of postoperative swelling.
Postoperative management usually includes strict cage confinement
and rest, nutritional support (e.g., syringe feeding with a high-quality,
appropriate canned food), analgesics, and maintenance subcutaneous
fluids if indicated. Systemic antimicrobial agents are not indicated with
most closed fractures or luxations. Ferrets that present with open frac-
tures or soft tissue injuries may require systemic antibiotic treatment.
The ferret’s appetite and fecal production and character should be moni-
tored closely. Ferrets as a species are susceptible to stress-induced gastri-
tis, enteritis, and ulcerations of the gastrointestinal tract, which can
result in melena or diarrhea. Ferrets that show signs of gastrointestinal
discomfort should be supported medically, which may include gastroin-
testinal protectants, subcutaneous fluids, and nutritional support. In the
authors’ practice, orthopedic ferret patients are kept in the hospital on
analgesic support until they are eating well and have normal food intake
and fecal production.
Close adherence to the recommended postoperative care is crucial
for successful healing. Thorough communication with the ferret’s owner
before discharge from the hospital is crucial to optimize the success of
the surgical procedure and a return to normal function. One of the
primary causes of failure of an orthopedic implant or device is inappro-
priate activity level of the ferret in the home environment. Strict cage
154 RITZMAN & KNAPP

rest and confinement is required for the postoperative management of

orthopedic repairs, and client education and compliance are key factors.
Adherence to the scheduled follow-up visits is also important to
allow the veterinary clinician to evaluate progress and healing. The
removal of orthopedic implants or external fixators is performed after
there has been adequate time to heal and after confirmation of adequate
healing has been obtained from radiographic imaging. Transarticular
pins are placed most optimally with both ends exiting the skin to allow
for easy removal.
The exact time of the recheck depends on the condition and the
surgical repair performed. Most ferrets with implants or external fixator
devices are scheduled for repeat physical examinations 2 weeks after the
surgical procedure. At that time, any external bandaging (if applied)
should be removed and the limb and surgical site should be examined.
Strict cage rest usually is continued for 4 to 6 weeks after surgery, with
most ferret patients returning in 4 to 5 weeks for repeat radiographs to
evaluate healing.
The removal of implants or orthopedic devices is performed after
confirmation of adequate healing and requires a brief period of general
anesthesia. The veterinary clinician may recommend additional activity
restriction after implant removal and should provide a defined schedule
for the owner to follow.

References

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3. Brown SA: Basic anatomy, physiology, and husbandry. In Hillyer EV, Quesenberry KE
(eds): Ferrets, Rabbits, and Rodents: Clinical Medicine and Surgery. Philadelphia, WB
Saunders, 1997, pp 3–13
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 FERRET ORTHOPEDICS 155

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Boards/B0120000/B0116194.htm

Address reprint requests to

Tracey K. Ritzman, DVM
Angell Memorial Animal Hospital
350 South Huntington Avenue
Boston, MA 02130

e-mail tritzman@angell.org