Practices that treat exotics or wildlife may be familiar with this situation: A person comes in with a turtle that has been run over by a car or chewed on by a dog and says: “Can you help?”

What do you do first? Triage is the initial step, according to Gregory Fleming, DVM, DACZM, a veterinarian at Disney’s Animal Kingdom. Fleming recently published a paper describing the process of assessment, treatment and rehabilitation for chelonians with shell damage. He also presented his work at the North American Veterinary Conference in Orlando, Fla., in January.

Difficult decision
Fleming says it is important to triage the patients and make sure the animals can be treated and (if they are wild) be released back into the wild. The five levels of prognosis are excellent, good, fair, guarded/poor, and grave. The first few hours are critical, he says, and if the patient is deemed to be too damaged to survive alone in the wild, euthanasia should be considered.

“This may be a difficult decision of life and death,” Fleming said in the paper. “However, with limited time and resources available, it is critical to quickly make this decision. Triage may also save months of work, emotional energy, and finite resources.”

Patients with a stable, closed fracture; hairline fracture or other fracture not involving the spine have the best chance of survival, Fleming says. On the other end of the spectrum, if the patient has multiple fractures; is missing 30 percent or more of the shell; or has internal, head, or spinal injuries; the prognosis is grave and the patient most likely cannot be treated.

Spinal injury may be difficult to assess in some chelonians, however, since tortoises are capable of “spinal walking.”

“Spinal walking consists of reflexive actions rather than conscious movement,” Fleming explained. “The entire spinal cord may be severed and spinal walking is still possible.”

Radiographs can show spinal damage, or the patient may present other neurological problems that become apparent with further observation.

NSAIDs, screws and wires
After the initial triage, it is important to initiate pain management. Fleming notes that reptile analgesia is an emerging field, and information on turtle and tortoise pain is quite limited compared with information on companion mammals and birds.

Fleming mentions butorphanol and morphine as possible analgesics, but says he has used the non-steroidal anti-inflammatory drug meloxicam in more than 20 species of reptiles with good clinical results.

In his paper, Fleming explains various methods of antibiotic treatment, fluid therapy, wound care and nutrition. He also explains how to stabilize the shell fractures using pieces of wire wrapped around machine screws placed in the shell. He mentions the use of epoxy as a popular method of repair, but says if the wound is open or infected, the epoxy can actually seal in the infection and lead to more problems.

Peer review
Douglas Mader, DVM, DABVP, of Marathon Veterinary Hospital in Marathon, Fla., said in general he agrees with the procedures laid out in Fleming’s paper.

“Everybody ties their shoes slightly differently, but in the end the result is the same,” Mader said.

Mader, who also treats chelonian patients, said he has seen “many, many, many” cases of turtles that have been run over and need shell repair. He said in addition to the screw and wire technique, other methods can also be effective.

“For simple fractures you can epoxy zip ties to the shell and connect the broken pieces together very efficiently with the nylon ties,” he said. “This technique obviates the need to drill holes in the shell, thus minimizing complications or potential additional bone injury or bone pain from the drill sites.”

In his conclusion, Fleming says that while the process is lengthy, surgical repair of chelonian shell fractures is rewarding and worthwhile.

“These reptiles often have life spans greater than 50 years,” he said. “By rehabilitating an adult chelonian, you are assisting with conservation as well as helping individual animals that are often overlooked and never treated.”

Fleming’s paper appears in the October issue of the Journal of Exotic Pet Medicine.