ORTHOPEDICS 1094–9194/02 $15.00
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ORTHOPEDIC RADIOGRAPHY IN
EXOTIC ANIMAL PRACTICE
Jamie Williams, MS, DVM, Diplomate, American College of
Veterinary Radiology

The radiographic examination of orthopedic disease is relatively

straightforward and follows guidelines for obtaining and evaluating
radiographs of axial and appendicular skeleton that already are estab-
lished for common pet species.1, 3–12, 14–16, 24–28 Orthopedic diseases common
in routine pet species (dog and cat) also are found in avian and exotic
species; however, avian and exotic species also exhibit rather unique
orthopedic diseases and unique responses to routine orthopedic mala-
dies. This article describes some of the common orthopedic insults that
are suffered by exotic animals and discusses some notable anatomical
differences and exceptions in response to injury when appropriate.
Knowledge of normal radiographic anatomy is critical when evalu-
ating patients for orthopedic disease. When faced with the prospect of
obtaining and then evaluating radiographs of avian or exotic pet species,
the practitioner may be intimidated by a lack of knowledge of normal
radiographic anatomy or disease entities of a particular species. As with
dogs and cats, however, there should be a bilateral symmetry of skeletal
structures. Published references that detail the normal radiographic anat-
omy of avian and exotic species may be used by the less-experienced
practitioner when reviewing the radiographs of birds, snakes, lizards,
rabbits, and turtles.3, 13, 16–24

From the American College of Veterinary Radiology, Department of Veterinary Clinical

Science, School of Veterinary Medicine, Louisiana State University School of Medicine,
Baton Rouge, Louisiana

VETERINARY CLINICS OF NORTH AMERICA:

EXOTIC ANIMAL PRACTICE

VOLUME 5 • NUMBER 1 • JANUARY 2002 1

2 WILLIAMS

RESTRAINT AND POSITIONING

Patient malpositioning during radiographic exposure is the most
common reason for nondiagnostic radiographs or misdiagnosis of dis-
ease, especially for those practitioners who either are new to exotic
diagnostic imaging or see only a few cases per year. Care and attention
must be paid to accurate patient positioning so that symmetry is max-
imized. Manual restraint may be sufficient in many exotic pets, espe-
cially for smaller, relatively calm birds, turtles, tortoises, and some liz-
ards. Chemical restraint (sedation or anesthesia), however, is extremely
beneficial for larger uncooperative patients, such as large birds or rap-
tors, snakes, ferrets, and even rabbits. Chemical restraint not only im-
proves radiographic quality by reducing patient motion but also allows
more precise positioning for the intended views and increases the safety
of the patient and technical staff. Sedation may be accomplished via
injectable products; anesthesia may be accomplished via injectable prod-
ucts or the tank or mask administration of gas agents (e.g., Isoflurane)
(Fig. 1). Patient monitoring (e.g., pulse, respiration, heart rate, body
temperature) is essential during sedation or anesthesia.
Positioning is improved or aided with the use of cloth tape; the
patient can be taped either directly to the radiographic cassette (Fig. 2)
or to a positioning device (bird board) made of acrylic (Fig. 3). Because
whole-body radiographs often are obtained, making the radiographic
exposure at peak inspiration is important, especially in species, such as
rabbits and prairie dogs, that have a disproportionately small thorax
compared with the abdomen. The vast majority of avian and exotic
patients are small in truncal diameter, and, therefore, films are often
exposed without the use of a grid. High-detail film and screen combina-

Figure 1. Mask administration of Isoflurane (Abbott Laboratories, North Chicago, IL) to a

ferret before radiography. (Copyright Jamie Williams, MS, DVM, Baton Rouge, LA; with
permission.)
 ORTHOPEDIC RADIOGRAPHY IN EXOTIC ANIMAL PRACTICE 3

Figure 2. Avian patient taped directly to radiographic cassette in ventrodorsal position.

Tape on the feet allows retraction during exposure. Note the mask administration of
Isoflurane to eliminate stress or movement in the patient during exposure. (Copyright Jamie
Williams, MS, DVM, Baton Rouge, LA; with permission.)

tions provide the best radiographic detail but require higher radio-
graphic techniques (kVp and mAs) for proper radiographic exposure.
Motion artifact is relatively more common in smaller patients because
of their more rapid respiratory and heart rates; therefore, exposure times

Figure 3. A, Acrylic positioning device (bird board). B, Ventrodorsal radiographic image of

an egg-bound avian patient using this device. (Copyright Jamie Williams, MS, DVM, Baton
Rouge, LA; with permission.)
4 WILLIAMS

should be kept at 1/60 second or less. As with the more common pet
species, two orthogonal (90 apart) radiographic views are necessary to
evaluate any body structure completely. For the truncal body, this is
accomplished with lateral and either ventrodorsal or dorsoventral views.
With small mammals (e.g., ferret, rat, hedgehog), orthogonal radio-
graphic views of the appendicular skeleton are obtained in much the
same way as for a dog and cat. The lateral view is relatively easy to
obtain in avian species; however, the orthogonal view of the wing is
more difficult and requires that the patient be held vertically in a head-
down position with the wing extended against the radiographic cassette
and aligned so that the radiograph photons penetrate the wing from
caudal to cranium. Radiographic examination of extremely small struc-
tures may be improved with nonscreen film. Dental film is one example
of nonscreen film; however, other single emulsion detail radiographic
film placed in a light-tight envelope may be used. Radiographic detail
is improved greatly with nonscreen film because there is no phosphor
bloom to blur the edges of the structures; the film is exposed directly to
the radiograph photons rather than to the light from the glowing or
activated phosphors of the radiographic screen. Unfortunately, this im-
proved radiographic detail requires higher exposure factors. It is well
known that radiographic film is five times more sensitive to room light
than radiograph photons; therefore, exposure factors must be raised
significantly when using nonscreen radiographic film. Usually, the milli-
amperage (mA) can be increased greatly while maintaining a short
exposure time to avoid motion artifact.
Many cage birds are relatively small, as are some of the exotic pet
species (e.g., gerbils, hamsters, rats, mice). Magnification radiography
can be employed to enlarge the radiographic images; however, there
is an inherent loss of edge sharpness. Magnification radiography is
accomplished by increasing the distance between the patient and the
film, in effect raising the patient off the film cassette and placing it
closer to the tube head of the radiography machine. Placing a thick
nonradiopaque device (e.g., square sponge) between the patient and the
radiographic cassette effectively results in magnification radiography. It
is imperative that the routine orthogonal radiographic views be obtained
first, with the patient placed directly against the radiographic film cas-
sette. Magnified images can be added to the basic study in the smaller
species, if desired, to enlarge the image of the smaller skeletal structures.
A better alternative is to purchase an inexpensive magnifying glass,
which decreases the number of radiographic exposures because the
magnified images are no longer necessary. Additionally, reviewing rou-
tine films with a magnifying glass effectively enlarges the radiographic
image without the loss of edge sharpness.
Turtles and smaller lizards may be placed on a small, rectangular,
nonradiopaque support (e.g., a sponge) during radiography. The tube
head is extended and rotated horizontally (parallel to the table surface),
with the radiographic cassette positioned vertically against the patient
to obtain the lateral or craniocaudal radiographic image (Figs. 4 and 5).
 ORTHOPEDIC RADIOGRAPHY IN EXOTIC ANIMAL PRACTICE 5

Figure 4. Depiction of horizontal beam radiograph to obtain a craniocaudal image of this

tortoise. The tube head is extended and rotated such that the radiograph beam is oriented
parallel to the tabletop, the patient (tortoise) is placed upon a non-radiopaque sponge, and
the radiographic cassette is held in place vertically behind the patient using sand bags.
(Copyright Jamie Williams, MS, DVM, Baton Rouge, LA; with permission.)

Using this positioning aid often allows a more true projection to be

obtained compared with manually holding the patient on its side for
vertical overhead tube exposure. Additionally, providing a small-diame-
ter stick to which smaller lizards can cling during the radiographic
procedure may be helpful. This may decrease their activity level, allow

Figure 5. Lateral radiographic image of a small lizard using the same equipment orientation
as seen in Figure 4, with the patient positioned to obtain a lateral radiographic image.
(Copyright Jamie Williams, MS, DVM, Baton Rouge, LA; with permission.)
6 WILLIAMS

Figure 6. Lateral radiographic image of a small chameleon obtained with horizontal beam
orientation. Note that the chameleon is grasping the small stick used to aid positioning.
(Copyright Jamie Williams, MS, DVM, Baton Rouge, LA; with permission)

them to feel more secure, and provide optimal positioning for horizontal-
beam radiography (Fig. 6).

UNIQUE SKELETAL FEATURES

Avian bones exhibit much thinner cortices than those normally

found in mammals.7, 14, 23, 24 It is well known that certain avian species
possess pneumatic humeri and femora.7, 8, 23, 28 Extensions of the intercla-
vicular (humerus) and caudal ceolomic (abdominal) air sacs invade the
medullary portion of these bones, decreasing their medullary opacity
(Fig. 7). When a fracture involves the pneumatic bones, subcutaneous
emphysema results, which can make the determination of an open
versus closed fracture more difficult. More importantly, because of this
free communication, it is possible for osteomyelitis to result from the
direct extension of air sacculitis or, conversely, for air sacculitis to result
from the extension of osteomyelitis.8, 23 The avian axial skeleton is also
rather unique, with three fused vertebral segments that are thought to
provide increased stability during flight. From an orthopedic standpoint,
the most clinically important of these regions is the synsacrum, which is
formed by ankylosis of the last several thoracic vertebrae, all the lumbar
and sacral vertebrae, and the first few caudal vertebrae.
Reproductively active female birds store calcium salts in the ulna
and tibia prior to beginning egg laying which results in significantly
increased opacity or hyperostosis of these particular bones (Fig. 8).14, 28
The increased opacity is diffuse, uniform, and seasonal. Avian tuberculo-
sis (Mycobacterium species) also has been reported to result in focal,
increased medullary opacity and periosteal proliferation, predominantly
in the long bones, as well as lameness.7, 8, 14
 ORTHOPEDIC RADIOGRAPHY IN EXOTIC ANIMAL PRACTICE 7

Figure 7. Ventrodorsal radiograph of a large avian patient demonstrating the decreased

opacity of the humeri and femurs typically found in avian species possessing pneumatic
bones. (Copyright Jamie Williams, MS, DVM, Baton Rouge, LA; with permission.)

FRACTURES OF THE APPENDICULAR SKELETON

Fractures in avian or exotic species are classified in the same manner

as that used for routine pet species. Fractures may be open (i.e., the
bone protrudes beyond the dermal surface or there is air within the soft
tissue of the fracture site) or closed, and complete (i.e., both cortices of
bone are involved) or incomplete (i.e., only one cortex is broken [e.g.,
folding fracture, stress fracture, greenstick fracture]). Fractures are fur-
ther classified as simple (i.e., one fracture line results in two fracture
fragments) or comminuted (i.e., multiple fracture lines result in more
than two fracture fragments). Recognizing whether the fracture involves
the articular surface of a bone is important, because proper realignment
of the fracture fragments and stabilization of the fracture site is impera-
tive. Significant degenerative changes, however, are likely to result.
Displacement of the fracture fragments may affect the treatment ap-
proach. The distal segment or fragment is always considered in the
wrong location when describing fracture displacement. In other words,
the location of the distal segment is always described relative to the
8 WILLIAMS

Figure 8. Close-up ventrodorsal view of the pelvic limbs of a female hawk. Note the
significant increase in osseous opacity of the tibiotarsal bones indicative of seasonal
hyperostosis in reproductively active female birds. (Copyright Jamie Williams, MS, DVM,
Baton Rouge, LA; with permission.)

proximal segment. A cranially displaced fracture has its distal segment

cranial to or in front of the proximal segment. Evaluating all fracture
segments for the presence of fissure fractures is critical. Fissure fractures
are incomplete fractures that involve only one cortex and are found
extending from the original fracture site. Evaluation for fissure fractures
can be especially trying in avian and exotic animals because their skeletal
structures are relatively small and thin, necessitating the use of a magni-
fying glass and careful scrutiny of the cortical margins adjacent to the
fracture site on orthogonal radiographic views. Failure to recognize
fissure fractures may result in a previously nondisplaced piece of bone
becoming a complete fracture secondary to implant placement. Fractures
that involve the immature physis (Salter–Harris fractures) risk asynchro-
nous growth and limb deformity.6
Animals with open fractures are at risk for osteomyelitis (Fig. 9),9
and therefore a delayed or nonunion fracture. All gunshot-induced frac-
tures are considered open; however, the heat involved in this trauma
often decreases the likelihood of osteomyelitis. Fractures that involve
the pneumatic bones of avian species are at greater risk for osteomyelitis
and for extension to the associated air sacs (air sacculitis). Avian have a
rather unique healing process in fracture repair: Periosteal proliferation
(callus) is reduced greatly compared with that of mammalian species,
and healing is predominantly through endosteal callus7, 8, 28 and fibrous
tissue proliferation. This is also true in reptiles which demonstrate a
similar response to bone healing.16 Based on mammalian criteria for
fracture healing, reptiles and other exotic animal species are considered
slow healers. In fact, it is not uncommon to visualize the radiolucent
fracture line, even though the bone has healed, because of the predomi-
 ORTHOPEDIC RADIOGRAPHY IN EXOTIC ANIMAL PRACTICE 9

Figure 9. Lateral radiograph of the fractured right wing of a bird. Note that the distal aspect
of the proximal segment of the radial fracture extends beyond the skin surface dorsally
(open fracture) and the comminuted fracture of the mid-diaphysis of the ulna. Soft tissue
swelling is associated with the fractures. (Copyright Jamie Williams, MS, DVM, Baton
Rouge, LA; with permission.)

nantly fibrous callus. As a result of this phenomenon, radiographic

assessment is recommended at 12 to 16 weeks after the injury to assess
fracture healing.16 Periosteal reaction is often more prominent in snakes
than in lizards or turtles. Entanglement or entrapment is the biggest
cause of traumatic fracture in caged birds, most often resulting from
inappropriate cage toys, chains, wires, and so forth.
Evaluating turtles for fracture is difficult because of their propensity
to retract their head, tail, and appendages into their shell. Occasionally,
self-exteriorization of a particular limb may suggest trauma to or an
abnormality of that limb (Fig. 10A, B, and C). Tape or rolled gauze may
be used to extract the limbs gently during positioning for radiography,
allowing a more thorough evaluation for potential fracture disease (Fig.
11A, B, and C). This same technique is used to evaluate the joints for
effusion or sepsis.
Traumatic fractures of the tibia are relatively common in chinchillas,
presumably because the tibia is longer than the femur. Chinchillas pos-
sess on extremely thin and fragile bone structure, which undoubtedly
predisposes them to fracture. Commonly reported causes for these frac-
tures include grasping the animal by its rear limb or it having caught
its rear limb in its cage.15 Nonunion fracture may result from these
traumatic fractures because applying external fixators to the fracture
site is difficult and soft bandages generally do not provide excellent
stabilization of these thin and fragile bones.15

FRACTURES OF THE AXIAL SKELETON

Fracture, subluxation or luxation of the vertebral column are rela-
tively uncommon in exotic species; however, vertebral fractures sec-
10 WILLIAMS

Figure 10. A, A tortoise with the self-exteriorization of the left rear leg. B, Dorsoventral
radiograph shows that the left rear leg remains exteriorized and that there is a fracture of
the proximal left femur. C, Close-up radiograph illustrating the normal posture of the right
rear limb and the abnormal posture of the left rear limb caused by the proximal femoral
fracture. (Copyright Jamie Williams, MS, DVM, Baton Rouge, LA; with permission.)
Illustration continued on opposite page

ondary to metabolic bone disease may occur. There are three fused or
ankylosed regions of the vertebral column in avian species, which results
in rigid sections, that are thought to stabilize the vertebrae during flight.
In terms of orthopedic maladies or disease, the most important of these
regions is the synsacrum (Fig. 12), which is formed by ankylosis of the
last several thoracic vertebrae, all the lumbar and sacral vertebrae, and
the first few caudal vertebrae. Birds are known to fly toward uncovered
windows, which results in craniocaudal impact when they encounter a
window that is closed. The most common site for traumatic vertebral
fracture that results from this impact is immediately cranial to the
fused synsacrum7, 8; therefore, this particular region must be evaluated
thoroughly for fracture or malalignment in all avian patients with sus-
pected vertebral trauma.
Fractures that involve the cranium are always difficult, even in
routine small animal patients. The difficulty is augmented in exotic
species owing to their reduced size, which results in a smaller radio-
graphic image. The normally thin cortical margin of the osseous struc-
tures of the skull makes determination of small fractures even more
difficult. Numerous air-sac extensions are found within the skull of
avian patients, which further complicates the radiographic recognition
of fracture.13 Skull fracture is easier to recognize if there is an obvious
malalignment or depression in the normal contour. In small exotic spe-
cies, such as lizards and ferrets, occlusal (intraoral) radiographs provide
increased radiographic detail, allowing closer scrutiny of the rostral
maxilla and mandible for fracture or lytic change (Fig. 13). Intraoral
radiographs are obtained by placing a nonscreen detail film in the mouth
 ORTHOPEDIC RADIOGRAPHY IN EXOTIC ANIMAL PRACTICE 11

Figure 10. See legend on opposite page

of the anesthetized animal. Because no intensifying screen is used, mAs

must be increased substantially; however, the detail that is obtained is
better than that provided by a detail film and detail screen. Masses or
soft tissue swelling of the head should be investigated radiographically
12 WILLIAMS

Figure 11. A, Close-up image of a dorsoventral radiograph of a tortoise. Tape applied to

the forelimb was used to gently extract the limb from superimposition of the shell during
radiographic exposure. B, A closer view of following demonstrates the thin radiopaque
linear structures extending from either side, secondary to the tape extraction aid, resulting
in a craniocaudal or dorsopalmar view of the forelimb. C, A lateral view of the limb again
visualizes the tape surrounding the distal aspect of the forelimb. (Copyright Jamie Williams,
MS, DVM, Baton Rouge, LA; with permission.)
 ORTHOPEDIC RADIOGRAPHY IN EXOTIC ANIMAL PRACTICE 13

Figure 12. Close-up of a lateral radiographic of an avian patient. The white bracket indicates
the synsacrum. (Copyright Jamie Williams, MS, DVM, Baton Rouge, LA; with permission.)

to determine the character of the associated osseous structures (i.e.,

evaluate for lysis or proliferation of adjacent bony structures) (Fig. 14).
The avian pelvis is fused to the synsacrum dorsally but is open
ventrally,8, 17–23 to allow passage of large, mineralized eggs. Traumatic

Figure 13. Mandibular occlusal (intraoral) radiograph of a Water Dragon Lizard (small
species) with rostral swelling. Note the expansile nature of the rostral right mandible
suggestive of osteomyelitis. This particular radiograph was made with nonscreen dental
radiographic film. (Copyright Jamie Williams, MS, DVM, Baton Rouge, LA; with permission.)
14 WILLIAMS

Figure 14. Lateral radiographic view of the skull of a rabbit presented for firm swelling of
the rostroventral mandibular region. There is no evidence of osseous destruction. (Copyright
Jamie Williams, MS, DVM, Baton Rouge, LA; with permission.)

pelvic fractures may be difficult to recognize in avian patients, especially

if axial rotation is present during positioning for the ventrodorsal radio-
graph. If careful attention is paid to accurate alignment and position,
then the practitioner need only compare the right side to the left and
evaluate for asymmetry (Fig. 15).
Vertebral fractures in exotic patients may result from metabolic bone
disease. Traumatic fracture or luxation of the vertebral column is the
most common cause of acute-onset posterior paresis in otherwise healthy
rabbits. The hindquarters of the rabbit are heavily muscled as a part of
its fight-or-flight apparatus. Lack of proper support during patient han-
dling is the most common reason for fracture or luxation of the vertebral
column, with the most common site being L7.4 Therefore, it is essential
that the hindquarters of the rabbit be supported securely during han-
dling to prevent explosive extension of the rear limbs, potentially re-
sulting in fracture or luxation of the vertebral column.

INFECTION, OSTEOMYELITIS, AND SEPSIS

Radiographic changes may not be readily apparent in the early

stages of infection or osteomyelitis.10, 14 Later in the course of disease,
however, soft tissue swelling, bone lysis, and aggressive periosteal prolif-
eration often are found. Local bone destruction is noted by lytic lesions
in a focal area, often at or near the site of fracture or penetrating
wound (Fig. 16A and B). Bone destruction and soft tissue swelling are
 ORTHOPEDIC RADIOGRAPHY IN EXOTIC ANIMAL PRACTICE 15

Figure 15. Close-up ventrodorsal avian radiograph depicting abnormal orientation of the
pelvis consistent with fracture of the right ileum. (Copyright Jamie Williams, MS, DVM,
Baton Rouge, LA; with permission.)

recognized more easily in the lower extremities, which normally have

reduced soft tissue thickness.
Septic arthritis is seen most commonly in the intertarsal joints of
caged birds.28 Open fractures, penetrating wounds, or iatrogenic causes
may result in osteomyelitis.8 Osteomyelitis also has resulted from hema-
togenous dissemination or extension from air sacculitis [pneumatic
bones], septic arthritis, and pododermatitis.4, 7, 8, 15, 16, 23 Because avian
species do not produce much periosteal proliferation during fracture
healing, similarly it does not occur extensively with infection either. In
fact, lysis is the predominant radiographic osseous abnormality with
both infection and neoplasia.8, 14 Increased periosteal proliferation and
increased medullary opacity, however, have been noted in cases of
fungal osteomyelitis or tuberculosis (Mycobacterium species).8 Osteomy-
elitis in reptiles also produces a primarily lytic reaction or response,
with little periosteal proliferation (Fig. 17A and B).6
Pododermatitis (bumblefoot) is common in guinea pigs, and osteo-
myelitis is possible in the distal extremities via direct extension.15 Ulcera-
tive pododermatitis occasionally may result in osteomyelitis or septice-
16 WILLIAMS

Figure 16. A, Lateral radiograph of an open gunshot fracture of the ulna of a hawk. The
small metallic opacities are indicative of gunshot, which is always considered an open fracture.
The significant periosteal reaction associated with the comminuted ulnar fracture, along with
the palpable increased temperature of the soft tissues is indicative of osteomyelitis in the
avian patient. B, Close-up craniocaudal radiograph of the swollen foreleg (elbow) of an iguana.
Note the loss of subchondral bone in the humeral condyle, proximal radius and proximal ulna;
the periosteal proliferation extending proximally on the distal humerus; and the significant soft
tissue swelling. These radiographic findings are indicative of osteomyelitis and septic arthritis.
(Copyright Jamie Williams, MS, DVM, Baton Rouge, LA; with permission.)

mia via direct extension in rabbits4; however, rabbits are prone to

abscessation (from P. multocia or Staphylococcus aureus). These abscesses
may affect the joints, long bones, or skull, resulting in osteomyelitis (Fig.
18A and B).4

PATHOLOGIC FRACTURES

Pathologic fractures are simply fractures of bone that had a pre-

existing disease (e.g., neoplasia, osteomyelitis (bacterial or fungal), meta-
bolic bone disease). Bone is a living tissue that is resorbed and redepos-
ited constantly. Natural stresses on existing bones determine where bone
salts are deposited; bone is remodeled according to Wolff’s law (i.e.,
according to the lines of stress). Metabolic bone disease is suggested
radiographically by generalized bone changes and osteopenia of multi-
ple bones of axial and appendicular skeleton. Exotic species seem to be
more susceptible to nutritional secondary hyperparathyroidism (fibrous
osteodystrophy secondary to nutritional imbalance). Animals that suffer
from nutritional secondary hyperparathyroidism demonstrate abnor-
 ORTHOPEDIC RADIOGRAPHY IN EXOTIC ANIMAL PRACTICE 17

Figure 17. Dorsoventral (A) and lateral (B) close-up radiographs of a snake with a periver-
tebral abscess and subsequent vertebral osteomyelitis. The perivertebral abscess (con-
firmed by way of fine needle aspiration) is seen as the soft tissue mass adjacent to the
vertebrae, while the osteomyelitis is suggested by the focal demineralization in the vicinity
of the soft tissue abscess. (Copyright Jamie Williams, MS, DVM, Baton Rouge, LA; with
permission.)

mally thinned cortices of long bones with decreased overall osseous

opacity (medullary and cortical) and also may exhibit pathologic frac-
tures (e.g., folding fractures, incomplete fractures) in these bones (Fig.
19A and B). It is not uncommon to recognize several fractured ribs along
with fractures of the appendicular skeleton in animals with subjectively
thinned cortices and a loss of normal bone opacity. Metabolic bone
disease with secondary pathologic fracture is more common than trau-
matic fracture in cage birds, according to McMillan.8
Guinea pigs are genetically susceptible to vitamin C deficiency.
Radiographic changes noted in scurvy (hypovitaminosis C) include en-
largement of the epiphyses of long bones and the costochondral junc-
tions of the ribs. Pathologic fractures also may result.15 Pathologic
fractures of the mandible may indicate renal secondary hyperparathy-
roidism, especially if the cortical opacity of the long bones appears
relatively normal or at least not as osteopenic as the mandibular cortices.
18 WILLIAMS

Figure 18. Dorsoplantar (A) and lateral (B) radiographic images of the swollen tarsus (3-
week duration) of a rabbit. Note the asymmetrical (extra-capsular) soft tissue swelling
located at the tarsocrural joint and distal tibia, but lack of significant periosteal reaction.
The asymmetrical distribution and irregular margination indicates the swelling is extra-
capsular rather than within the joint proper; and the lack of significant osseous reaction
suggests the lesion is somewhat benign. Fine needle aspiration confirmed abscessation.
(Copyright Jamie Williams, MS, DVM, Baton Rouge, LA; with permission.)

Spinal lymphoma is reported rarely in ferrets but may result in patho-

logic fracture of the vertebrae.2

JOINTS: LUXATION, SUBLUXATION, AND

DEGENERATIVE CHANGES

Joint instability is not tolerated by the body; however, the response

of bone or joint tissue is rather limited. The body’s natural response to
joint instability is to produce more bone in an effort to increase stability,
resulting in the periarticular osteophytes seen commonly in degenerative
joint disease. Instability often results in increased synovial mass, either
via joint effusion or hypertrophy of the soft tissue of the joint. This
increased synovial mass stretches and distends the joint capsule, putting
stress on the osseous attachments of the joint capsule. Specialized fibers
(Sharpey’s fibers) in the joint capsule allow its attachment to bone and
form an enthesis (i.e., a point of soft tissue insertion into bone). When
stretched, Sharpey’s fibers mineralize in an effort to restore stability and
tighten the joint capsule. This mineralization results in enthesophytes,
which are seen in degenerative joint disease. Spontaneous cartilage
degeneration has been reported in guinea pigs, resulting in degenerative
changes and arthritis of the stifle joint.15 Additional radiographic signs
 ORTHOPEDIC RADIOGRAPHY IN EXOTIC ANIMAL PRACTICE 19

Figure 19. Ventrodorsal (A) and close-up (B) abdominal radiograph demonstrating the
folding fracture of the distal right femur in a young raccoon. The cortices of all bones,
especially the long bones, are significantly thinned, suggesting metabolic bone disease
(fibrous osteodystrophy). (Copyright Jamie Williams, MS, DVM, Baton Rouge, LA; with
permission.)

of joint disease commonly evaluated in dogs and cats are more difficult
to ascertain in exotic or avian species. Joint effusion may be particularly
difficult to evaluate in smaller exotic species such as hamsters, mice,
and gerbils simply because the overall size of the joint is so small; the
presence of joint effusion is easier to note in rabbits and other larger
species. In exotic or avian species, the radiographic evaluation of joints
for enthesophytes is difficult owing to the small area of interest. Joint
laxity results in either subluxation or luxation, depending on whether
any portion of the articulating surfaces is still in contact or not (i.e.,
luxation is a more severe disruption of normal joint articulation than is
subluxation). Luxation and subluxation certainly have been documented
in avian and other exotic animal species. Although luxation is deemed
uncommon,8 it seems to be most prevalent in the coxofemoral joints,
stifles, and digits of birds.8, 14

EXOSKELETON
Animals that possess an exoskeleton or a hard external shell (e.g.,
tortoise, turtle, armadillo) present yet another opportunity for radiogra-
20 WILLIAMS

phy. If external trauma involving the shell is noted, radiographs are

indicated to determine the extent of internal damage as well. Turtles
and tortoises exhibit an intimate attachment of the vertebral column
with the shell; therefore, damage to the shell may result in damage to
the vertebral column. Furthermore, depending on the type or force of
trauma, internal hemorrhage or lung contusion may result (Fig. 20A, B,
and C).

SUMMARY

Radiographic examination of exotic animal species provides signifi-

cant diagnostic information to the practitioner so long as attention is
paid to positioning and radiographic detail and if variations in normal

Figure 20. Lateral (A) and dorsoventral (B) radiographs of a tortoise presented for fracture
of the caudal left aspect of the shell. There is no radiographic evidence of fracture or
subluxation involving the vertebral column, the pelvis, or the left femur. The craniocaudal
radiograph (C) confirms pulmonary contusion secondary to the initial trauma. Note the
increased soft tissue opacity of the lungs in the dorsal aspect of the coelom. (Copyright
Jamie Williams, MS, DVM, Baton Rouge, LA; with permission.)
 ORTHOPEDIC RADIOGRAPHY IN EXOTIC ANIMAL PRACTICE 21

radiographic anatomy are contemplated. Fracture of pneumatic bones

(humerus or femur) in avian patients often results in subcutaneous
emphysema, much like an open fracture. If fracture alignment is anatom-
ical, there is generally little callous formation visible in avian and reptile
patients; however, if malunion occurs, then certainly callous can be
visualized. Aggressive or excessive periosteal proliferation in exotic spe-
cies often predicts osteomyelitis.
Practitioners can increase their diagnostic capabilities and thereby
decrease any preconceived anxiety by applying the same general inter-
pretive concepts used in the radiography of more routine small animal
patients and by evaluating the resultant radiographs in a systematic
manner. With the exception of certain anatomical differences and alter-
ations in response to injury, exotic animal species suffer the same types
of orthopedic disease do dogs and cats.

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Address reprint requests to

Jamie Williams, MS, DVM
Department of Veterinary Clinical Sciences
School of Veterinary Medicine
Louisiana State University
Baton Rouge, LA 70803