ISSN 2398-2985      

Shell repair

Jreptile

Introduction

  • Shell injuries are one of the most common reasons for chelonians to be presented to a veterinary practice. They can occur for example, for the following reasons:
    • Falls, drops.
    • Lawnmower/strimmer accidents.
    • Hit by a vehicle.
    • Hit by a falling object.
    • Dog bites and other predators .
    • Blunt trauma by another tortoise.
    • Fire damage.
    • Abscesses and infections.
  • The approach varies depending on the nature and severity of the damage, ranging from conservative wound management and supportive care to more proactive and intensive reparative surgery.
  • Management and repair of shell injuries follows many of the same basic principles as skin wounds in other species, but with some specific considerations relating to chelonian anatomy.
  • All chelonians should undergo initial assessment and triage and a treatment plan determined accordingly.
  • All animals should receive supportive therapy which might include all/any of the following:
    • Analgesia.
    • Antimicrobials.
    • Fluid therapy.
    • Nutritional support.
    • Adequate environmental temperatures for the species.
    • All wounds should be cleaned and, where appropriate, suitably bandaged/dressed  .

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

  • Dependent on the type of injury +/- involvement of underlying structures, eg spine, coelom.
  • Examples of excellent, good, fair, poor and grave prognoses include:
    • Excellent:
      • Single, stable and minor/hairline fractures, that do not involve additional structures, eg spine.
      • Chelonians which are bright, alert, otherwise well.
      • Often these patients require only supportive care and no surgical stabilization.
    • Good:
      • Multiple, unstable, mild open fractures; no or only small pieces of shell missing.
      • Shell punctures, eg dog bites.
      • No exposure of underlying coelom or organs.
      • These patients will require surgical stabilization of the fractures as well as supportive care. Their treatment and recovery will take weeks to months.
    • Fair:
      • Multiple fractures involving shoulder or pelvic area, provided the chelonian is still ambulatory (if not, prognosis is poor to grave). Note: fractures affecting the limbs carry a more favorable prognosis in aquatic than terrestrial species.
      • Punctures which penetrate the coelom.
      • These patients will require surgical stabilization of the fractures as well as supportive care. Their treatment and recovery will likely take months.
    • Poor/guarded:
      • Open fractures or puncture wounds exposing viscera.
      • Gross contamination of the coelom.
      • In these cases, further diagnostics are warranted to assess the extent of the injuries and guide decision making regarding options for further treatment and prognosis.
      • These patients can be difficult to treat successfully.
    • Grave:
      • Multiple fractures, internal injuries, head injuries.
      • Fractures involving the spine. Note: these can be difficult to diagnose on radiography alone; a neurological exam must be carried out and urinary and fecal continence assessed (take care as tortoises are capable of spinal (reflex not conscious) walking which can mask spinal injury).
      • In these instances, euthanasia is the recommended option.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Hedley J, Woods S & Eatwell K (2013) The use of negative pressure wound therapy following subcarapacial abscess excision in a tortoise. J Small Anim Pract 54 (11), 610-613 WileyOnline.
  • Fleming G (2008) Clinical technique: chelonian shell repair. J Exotic Pet Med 17 (4), 246-258 JExoticPetMed.
  • Adkesson M J, Travis E K, Weber M A et al (2007) Vacuum-assisted closure for treatment of a deep shell abscess and osteomyelitis in a tortoise. J Am Vet Med Assoc 231 (8), 1249-1254 PubMed.
  • Barten S L (2006) Shell Damage. In: Reptile Medicine and Surgery. Ed: Mader D. Saunders Elsevier, USA. pp 893-899.
  • LaFortune M, Wellehan J F X, Heard D J et al (2005) Vacuum-assisted closure (turtle VAC) in the management of traumatic shell defects in chelonians. J Herpetol Med Surg 15 (4), 4-8 VetMedResource.

Other sources of information

  • Roffey J & Miles S (2017) Turtle Shell Repair. In: Reptile Medicine and Surgery in Clinical Practice. Eds: Doneley B, Monks D, Johnson R & Carmel B. pp 397-408.
  • Eatwell K (2015) Managing Tortoise Shell Injuries. In: Vet Times. Website: www.vettimes.co.uk. Last accessed 11th May 2018.
  • Fleming G (2014) New Techniques in Chelonian Shell Repair. In: Current Therapy in Reptile Medicine and Surgery. Section II: Advances in Anesthesia, Surgery and Analgesia. Eds. Mader D & Divers S. Elsevier, USA. pp 205-212.
  • Chitty J & Raftery (2013) Fractures of the Shell. In: Essentials of Tortoise Medicine and Surgery. Wiley Blackwell, UK. pp 216–221.
  • Hernandez-Divers S (2004) Surgery: Principles and Techniques. In: BSAVA Manual of Reptiles. 2nd edn. Eds: Girling S & Raiti P. pp 164-165.
  • McArthur S & Hernandez-Divers S (2004) Surgery. In: Medicine and Surgery of Tortoises and Turtles. Eds: McArthur S, Wilkinson R & Meyer J. Wiley Blackwell, UK. pp 403-464.

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