How To Fix A Cracked Turtle

 

How To Fix A Cracked Turtle

If you click on my image I'll show you what happened to me and a cousin of mine not too long ago..

 

Then read below to see in detail how our fix was done

 

Ron Hines DVM PhD ...........................

Orphaned wildlife tend to knock more than once on the door of a kind- hearted person .

So, for baby cottontail rabbits, go here, opossums, here , raccoons, here ,squirrels here and here. Turtles here. Bobcats and other such creatures are for professionals only, go here.

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Please don't be intimidated by the number of surgical instruments and products I use when repairing these little guys. Eighty percent of those things are donated to me (or you) by mobile surgical instrument repair services and hospital in the area.They are generally thrilled that things they had destined to be discarded can have a second life - instruments, short-dated medical products and turtles. Donations pay for the rest.

Turtles and tortoises have amazing powers to recover from accidents - when given a little help.  Their outcomes give a lot of cheer to wildlife rehabilitators who have few or no treatment options that will return severely injured birds and mammals to the wild. That is because broken wings, arms and legs can rarely be restored to 100% efficiency; but many turtle and tortoises with severe shell fractures, given proper attention and a period of rest and recovery, do just fine.

Far and away the greatest threat to these shelled creatures are automobiles. Turtles are slow, giving multiple vehicles opportunities to hit them, and near misses just lead to prolonged periods of withdrawal into their shells.

This article concerns a particular sort of break I see frequently. It does not concern multiple shell injuries that result in substantial floating or missing portions of the shell - or severe fractures with internal injuries like these:

One has to question if attempting to repair those severely injured turtles and tortoises is a kind thing to do. Despite initial "success" , no one has ever studied how long those animals live, the pain they endure or how well they do in the wild after they have been released.  Predators and starvation will weed out those that are not 100% fit and, with time, large patches tend to come loose or trap infections in water-dwelling turtles. I personally believe that is more humane to put them down.   If you have a comment to add about that, write me and I will post it here. For the rest of this article, I use “turtle” for tortoise unless something applies only to tortoises. 

Here Are Some Important Things To Keep In Mind :

1) First off – turtles bite. They bite hard and they can reach farther back toward your fingers than one might suppose. They also carry salmonella. Wash your hands after every encounter with a turtle or with the contents of an aquarium that contained one.  If you have chronic health issues yourself, consider if your really want that exposure.

2) Fractured turtles are often more severely injured than first meets the eye. Their body organs have usually been severely compressed. That can result in issues that are considerably more important than a cracked shell. Does the turtle have blood, liquid or air bubbles coming out its nose? Do all of its feet function normally? Withdrawal from a toe pinch is not sufficient to confirm that – you need to observe synchronized leg movement. Are the turtle’s eyes bright or are they sunken from dehydration? Although egg laying and normal wandering can be the stimulus for an over-land trip, so can poor water conditions in their pond. Cracks (fractures) in the carapace (upper shell) are usually apparent. But it is very common for a hairline crack to also be present where the carapace attaches to the plastron:

I pass a Q tip saturated with 3% hydrogen peroxide which causes these tiny cracks to bubble and foam - a good way to confirm or discover them. Rehab facilities with financial resources greater than I have anymore can sometimes see those cracks better on x-rays than with the naked eye: (photos not the same turtle)

Peroxide is also helpful in detecting fly maggots in the wound, which can then be plucked out with tweezers. Swabbing peroxide solution on  - rather than poring or dribbling it into deep wounds – prevents it from entering the body cavity itself. Few folks reading this article have access to the facilities necessary for an in-depth turtle health work up. But should they, a turtle’s health exam can be just as detailed as an ER examination for you. (ref)

3) Get a feel for a normal turtle’s weight. Is this animal too light? When I lived in Florida, many cracked and non-cracked Eastern gopher tortoises were brought to me.

That was because of intense land development in Sarasota and Manatee counties. In order to pass state ecological rules for home development, a FWC inspection was not ordered by developers until all the resident tortoises had been collected and dumped elsewhere. Eastern gopher tortoises are intensely territorial. Their burrows must not be in eyeshot of another tortoise. In the fights that ensue, the losers often seeked greener pastures that require crossing vehicle throughways. Those that did not were stressed (immunosuppressed) to the point of developing active respiratory tract mycoplasma infections. (ref)  There is no cure for this disease once it is established in a tortoise or turtle. Mild cases often go into remission with TLC, proper nutrition and a low stress environment. That is reason enough to hold tortoises in separate enclosure with no eye contact between them.

Dehydrated aquatic turtles, and all turtles away from their natural environments for prolonged periods, are also abnormally light. I rehydrate those turtles with physiological saline (pss) I obtain from a local hospital. Some vets believe that pss or ringer’s solution are not appropriate for reptiles. They suggest a more dilute formulation (“reptile ringers”, “turtle saline"). I have never found that the standard human and veterinary formulations cause problems when given to turtles in appropriate amounts. I always give them by subcutaneous injection. Sometimes combined with sterile 50% dextrose to yield about a 2.5% dextrose-containing solution.

4) You need to be hygienic and as clean as possible when working on all injured animals. But there is no need to dress like an operating room surgeon during this procedure. The turtle is considerably more contaminated with bacteria than you are and no amount of scrubbing will change that. Besides, the bacteria that colonize turtles are not the same ones that colonize your skin or exist in your breath. They are cold-blooded reptiles with their own bacterial flora. Turtles, like all reptiles, have an immune system and body defenses against infection that are quite unlike yours. They rely on compounds like beta-defensin, which tend to localize infections and prevent them from spreading through the creature’s body (becoming "systemic") and on their innate (non-specific) immune system considerably more robust than warm blooded creatures. (ref1, ref2, ref3, ref4) Their immune system is also active at lower temperatures. (ref)

The downside of that process is that cheese-like (caseous) lumps tend to form in the infected areas that are not eliminated like pus (in mammals) but have to be manually scooped out to allow the healing process to complete. Another is that this cheesy material has little or no blood circulation within it. So antibiotics have a tough time killing the bacteria or fungi that dwell within the material.  When I sterilize clean stainless steel wires, drill bits and surgical instruments in this procedure, I do so through “flaming” with a butane cigarette lighter such as the one pictured in this photo:

5) Most folks know that a turtle or tortoise’s shell is made up of smaller organized bony sections covered with a thin fingernail-like keratin coating (the scutes). These bony sections are connected to each other through fine, saw-like lines borders called sutures. What many folks do not realize is that cracks generally follow the margins of these sutures – not the margins of the scutes.

That needs to be taken into account when deciding where to drill holes meant to keep broken shell portions in as close a contact as possible so they can heal. If the sections are brought together well, they should fit together like the halves of a love locket. To hold, holes need to be drilled considerably back from the edge because turtle shell is made up of “foamy/spongy” cancellous bone– with voids and chambers - like the bone of your ribs or skull. 

6) Not all turtles of the same size and species are going to heal at the same rate. Season, temperature and a prior life in stressful conditions can all influence that rate and ability. (ref1, ref2)

7) Poor environment is also a stimulus for turtles to migrate – so your particular turtle may not have been in its best health before it was run over. That also plays into your decision as to whether it would be wise to return the turtle to the same body of  water from which it came. (ref1, ref2, ref3)

Some states, have strict rules that turtles (ie tortoises) must be returned to the exact location where they were originally found. (eg Texas, Florida). That is because they fear that relocating them might spread mycoplasma disease to uninfected populations.

8) Do not be in any hurry to attempt to permanently close or seal a fractured turtle. After thoroughly cleaning the wounds (#3 below), you can approximate the shell portions with Gorilla tape once the wound has been cleaned and the surrounding shell cleaned with a “Scotch Brite- type green scouring pad. Leave it open at both ends so antiseptics can be applied and so it can drain (Tegaderm and stoma adhesive patches , cut to size, work well too – if you have a hospital source for them).  Reptiles have a truly amazing power of healing and regeneration. (ref)

9)  Fractured turtles are best kept in storage tubs with a substrate of damp towels -  tortoises in dry enclosures without bedding that can enter or contaminate wounds. Cover the tub with window screen to keep out flies. I place a candy thermometer in a small beaker of water within the environment and keep the temperature at about 85F (29C) with an above lamp and 100 watt incandescent lamp.

The Procedure :

If you scroll down to the very bottom of this article, you will find a series of photographs that show various steps in the procedure. If you enlarge them, you will find some explanatory notes. Two sliders came in the week I took those photos. So the series represents views to two animals. Some are just posed views - that is why you see wires already in place. If these photos are not sufficiently self explanatory, you can write to me.

1) You can judge how long a turtle has been seriously cracked by the odor of its wound. As tissue degrades and bacteria colonize it, odor becomes more pronounced. Low air temperature slows both processes.  Examine the animal closely for cracks, some carapace cracks might be quite apparent but some may not – particularly those on the lower shell (plastron).

2) Never submerge a cracked turtle in water – keep them “dry docked”. Water allows bacteria and fungi to penetrate deeper into the animal’s body.

3) In tortoises in particular, plant debris and soil tend to imbed themselves deep in these wounds. When the body cavity is exposed, that material even enters there. I generally pick whatever foreign material I can discover out with Bayonet or ear forceps. When I have done the best I can, using a 5 or 10cc syringe with a 1.5 inch 22 gauge (Ga) needle, I hold the turtle upright (show head up) and direct a gentle stream of sterile physiological saline into the highest point of the crack. That removes finer debris. Do the best job you can but do not use any form of spreader for better visualization. That causes further trauma. What small amounts of debris you miss, the turtle’s body will wall off.

4) Antiseptics and antibiotics diluted with saline and gently flushed with a hypodermic needle and syringe through a carapace fracture that does not penetrate into the body cavity (its coelomic cavity) is very helpful in controlling infections. If there is any possibility that the wound penetrates the body cavity, I hold the animal upside down when doing this. If I am sure there is penetration into the body cavity, I just swab the wound out with the mixture. I generally I rely on two antiseptics, chlorhexidine solution and hydrogen peroxide, when cleaning these fractures. I pat the excess solution off of them with absorbent napkins and then blow-dried them. I shake dry cefazolin antibiotic powder into the wound (roughly in an amount similar to salting or seasoning food). The 1gm vial’s cap can be pried off. After that, I gently pass a swab dipped in povidone iodine solution over the area (not povidone iodine scrub).

 

Be very cautious when using human blow driers on animals. Always keep you hand in the air stream so you know if it is too hot.  I re-swab them with hydrogen peroxide solution daily until it produces no foam. Then I know that the wound has sealed and healing has begun.  When the wound is severe, I occasionally give these animals an injection of Batryl and cefa  (enrofloxacin 3-5mg/1000gm and cefazolin, 10-20mg/1000gm both diluted in a large volume of sterile saline) under the skin above either front leg. Besides reducing the irritating effects of enrofloxacin, the added dilution fluid is helpful to dehydrated animals.

5) I generally wait a week or two before attempting to closely realigning the fracture site. Until then, tap or adhesive strips can be used to minimize the gap(s). Ideally, there will be an intact row of marginal scutes on either side of the carapace fracture. Applying any form of device or drilling into the shell at that location does not endanger body organs or give an easy entrance rout for infection. My choice material for making a metal shell alignment device is 18 or 22 gauge malleable medical stainless steel wire (in the trade, referred to as cerclage wire). (ref)  I purchase generic spools of this wire from Henry Schein. I also occasionally use a finer high quality aircraft grade of stainless wire that mics at 0.5mm. The 18Ga wire mics at 1mm and the 22Ga at 0.7mm. Stainless steel wire comes in many harnesses (flexibilities). You want the softest, most flexible medical grade, which will be the easiest to bend. It must be non-magnetic for it not to rust.

6) A healthy body immediately tries to wall off wounds that offer bacteria an entrance into the body. It often takes my sliders and gopher tortoises a week or two to do that. By that time, the fracture site has no drainage and there is no necrotic odor. Those versed in human diabetic wound care face the same situation. Daily or twice daily application of hydrogen peroxide speeds the healing process. Only at that point should any form of permanent closure be contemplated.

7) Some folks assume that turtle cannot sense pain, such as that of a drill, through their shells. That is untrue. (ref1, ref2) That is why I utilize isoflurane anesthesia gas before drilling into the turtle's shell. Veterinary and human anesthesia machines are not constructed to anesthetize creatures as small as the ones I work with, so I constructed this one myself out of hospital odds and ends. The "face mask" is a pill bottle with the bottom cut off :

I am not saying that you have to or should do that. Turtles can hold their breath a long time, so I can never be sure how much of the gas enters their bodies. However, they appear to struggle less after they are place in the nose cone for a while. I do not use a rebreathing, gas conserving system with these small animals. Anesthesia gases, like all volatiles, are not healthy for you to breath frequently. So you might want to consider if you really want to subject yourself to that risk. A little lidocaine like your dentist uses, applied to the location once drilling has begun, might be an alternative. But I have not tried that.

8) The safest location to place retention wires is along the outer border of the carapace. Cracks to the front or rear of the turtle can generally be closed by drilling a hole at an angle that begins at the shell skin line and emerges at the surface farther in (drilled upward at about a 30 degree angle). Passing the wire through the first hole is quite easy. But bending it around like a staple and inserting it into the second hole can be difficult. For that, I use a large hypodermic needle like this one

I have forgotten where I obtained them. They are, perhaps, 12Ga, but they OD mic at 2mm. When twisted and advanced through the drilled hole from the top, they ream out the second hole. Once the tip of the needle emerges from the underside of the shell, the 18Ga wire fits snugly within this needle and the wire can be advanced until it has emerged above the shell and the needle then backed out.

When I make holes in a turtle shell to accommodate a length of 18 Ga wire snuggly, I use 1.5 mm drill bits such as these.  

I use a flexible shaft drill that I constructed.

Had I the money, I would purchase a Foredom.

In addition to the surplus medical instruments available to me, jeweler’s grade tools are quite helpful in these repairs. Between turtle surgeries, I soak stainless steel instruments in diluted bleach, then rinse and dry them. A rice cooker makes a good sterilizer. Instruments that are not stainless are wiped down with isopropyl alcohol. When the cleanliness of any metal is in doubt, a butane lighter’s flame passed over them assures that they are sterile - things like drill bits and stainless steel wire.

9)  The flexible wire is then slowly snugged up – gently pulled a little on one side and then the other until the two sides of the crack fit as snuggly together as possible. In many cases, they fit so snuggly that no crack is visible to the eye. I modified a pair of hospital backhaus towel clamps which I sometimes use to maintain the shell in proper alignment while I am working. A drill bit nick on either side of the crack allows the points to grasp the shell.

10) When repair is complete, keep aquatic turtles in a container/tub lined with moist paper towels for 4-7 days. Swab off their shells with water several times a day and continue to swab the cracks with hydrogen peroxide. After that, remove the wet towels and fill with enough water to cover only their toes. I let tap water set for 48 hrs before using it to let chlorine dissipate.  (That really may be unnecessary as we maintained our sea turtles in 1ppm chlorinated water for years at Sea World and my home city water is 1.5 the rehab tap and 0.14 at my most distant tap from the meter) (ref)

Tortoises need no moist towels and go back to a large leaf substrate 4 days later. Over the coming weeks, I gradually increase the depth of the water and add flat stones for them to haul out on.   A 100-watt bulb in a desk lamp pointed at one area of the container maintains my thermometer temperature at 85F. In my experience, these recovering turtles prefer to spend most of their time basking on the rocks rather than in the water. The tub needs to be large enough for the turtles to have a temperature gradient so they can choose the temperature that suits them (their preferred optimum temperature zone or POTZ) for rapid healing to take place.

11) I am not a fan of patching aquatic turtles with fiberglass, epoxy glues or other products. Sure, they initially look good and turtles released with those patches probably do survive for a while. I do apply a thin layer of JB weld over the repaired crack. But I know that it is no more than a temporary Band-Aid that soon falls off. But a turtle’s shell is dynamic and none of these products actually bond to living bone or scutes. Eventually, those patches all trap bacteria and rotting debris between them and the living shell. No one has ever studied how long these released creatures actually survive. Aquatic turtles with these large defects are probably best maintained in captivity in shallow water for the rest of their lives. Plastilina makes a good temporary defect filler that can be removed now and then for examination and treatment until the area is fully healed, as in this photo:

The same goes for turtles that have lost a front foot or leg. My experience with sea turtles that were missing front limbs is that they never adapted sufficiently to forage. Instead, they swam in tight circles that precluded purposeful feeding activities. Tortoises seem to do considerably better long term when wired and patched. This one (a Texas gopher) had no further health issues over the year I kept him before he was release back to where he was found. A light hand buffing with medium grade steel wool will remove the epoxy shine.