CrackedTurtle Shells

Kattrina AinsworthOnyx

Due: June 25th, 2012

Turtle Shell Terminology

• Carapace– Dorsal, convex part of the shell structure.– Consists of the animal’s ribcage and spine combined with

dermal bone.• Plastron – Nearly flat, ventral surface.

• Scutes– Structures formed by overlapping sheets of keratin that

cover a turtle.• Carapace scutes: Nuchal, marginal, vertebral, costal, and

supracaudal.• Plastron scutes: Intergular, gular, humeral, pectoral, abdominal,

inframarginal, femoral, and anal.

Plastron

Carapace

Scutes

Scute Anatomy & Terminology

Carapacen. Nuchal

m. Marginalv. Vertebral

c. Costalsc. Supracaudal

Plastronig. Intergular

g. Gularh. Humeralp. Pectoral

a. Abdominalim. Inframarginal

f. Femoralan. Anal

Common Causes of Shell Injuries

• Crushing– Hit or run over by cars• Most common

– Injured by lawn mowers or other lawn equipment– Attacked by pet• Usually a dog

– Injury during fights• Between males or during mating

• Dropping

SeverelyFractured

TurtleShells

Treatment for Minor Shell Injuries

• Clean the wounds using gauze or damp paper towels and remove as much dirt and blood as possible.– Take care not to dislodge any clotted blood as this could restart

the bleeding.• Once debris is thoroughly cleared, use betadine solution

(One part betadine and 9 parts water) on gauze to gently clean the wounds.

• If actively bleeding place continuous pressure on the wound with gauze for 10 minutes or until bleeding has slowed.

• Medical adhesive tape or glue can be used to bind small cracks.

Treatment for Severe Shell Injuries

• Gently de-bride the exposed tissues.• If fragmented, remove loose pieces.• Flush wounds.• Clean wound margins with betadine solution on sterile

gauze.– Do not use betadine solution with exposed tissue.

• Antibiotics should always be given.– Turtles can develop peritonitis and septicemia from bacteria

that gets trapped under the shell or in any open wound.• The first signs seen are reddening or pooling of blood under the

plastron.

• Most severe shell injuries will require surgical intervention.

Shell Re-alignment• Before any repair can be performed, it is essential that the

affected area be clean and free of any infection.– Often requires several days of adequate cleaning and antibiotics.

• Re-alignment should be done under general anesthesia.• Fragmented injuries or missing pieces are commonly

replaced/repaired with an epoxy resin set over fiberglass or surgical steel mesh.– Dental and orthopedic cements or acrylic are also used.

• Cracks in the shell often only require binding until natural healing occurs.– Zip ties or external metal fixators.

• Healing is slow, often >1 year.

1 2

3

Common shell repair methods:

1)Zip ties

2)Metal external fixators

3)Acrylic shell replacement

Drug use in Turtles• All mentioned drugs are used off-label.• Triceps are the preferred site of administration

for IM injections.• SQ injections are most commonly given in the

loose skin near the shell margins of the fore or hind limbs.

• The right jugular vein is the preferred site of administration for IV injections.

Betadine• Povidone-iodine (Betadine)– Topical antiseptic– 2 forms:

• Solution- Sold OTC for cleaning minor wounds. – Solutions are 10% povidone-iodine in water.

• Surgical scrub- Sold OTC as a skin cleanserand disinfectant.– Scrubs are a mixture of povidone-iodine and

detergent.

– Uses in hospital setting as part of a regimen for post-exposure prophylaxis (PEP).

Anesthesia• Tiletamine-Zolazepam (Telazol)

– 4-10mg/kg IM or SQ.– Induction time of 15-30 min.

• Reverse with Yohimebine 0.1-0.15mg/kg IM or IV

– SE: Cardiac and respiratory depression.– Contraindications: Should not be used in patients

that have previous signs of hypersensitivity.– MOA: Acts as noncompetitive antagonists

of NMDA receptors in the CNS• Proprofol

– 5-10mg/kg IV.– Induction time of 5-20 min.– SE: Respiratory depression, apnea, hypotension

and pain at injection site.– Contraindications: Use caution in elderly

or patients with cardiovascular/respiratorydisease..

– MOA: Potentiating GABA receptor activity, slowing channel-closing time.

Analgesics• Butorphanol

– 0.2-0.4mg/kg SQ or IM SID as needed.– SE: Dizziness, nausea, vomiting and

constipation.– Contraindications: Use caution in

elderly patients and those with pulmonary, renal or hepatic impairment.

– MOA: Mixed agonist/antagonist (kappa agonist, mu antagonist)

• Buprenorphine (Buprenex)– 0.005-0.02mg/kg IM SID as needed.– SE: drowsiness, vomiting, dry mouth,

miosis, constipation, urinary retentionand respiratory depression.

– Contraindications: Use cautionin elderly patients.

– MOA: Partial agonist activity at mu-opioid receptors.

Anti-inflammatories• Carprofen (NSAID)(Rimadyl)

– 1-4mg/kg PO, IM, SQ or IV SID as needed.– SE: Limited GI ulceration, hepatotoxicity

or nephrotoxicity compared to other NSAIDS.– Contraindications: Should not be used

in patients that have previous signs of hypersensitivity.

– MOA: Inhibits cyclooxygenase activity.• Prednisolone (Anti-inflammatory)

– 2-5mg/kg PO or IM– SE: fluid retention, constipation, nausea,

muscle weakness,and bloody or black tarry stool.

– Contraindications: Use caution with long term use. Avoid use in pregnant patients.

– MOA:Binds with glucocorticoid receptors (alpha and beta).

Antibiotics• Amikacin sulfate (Amiglyde-V)

– Loading dose of 5mg/kg IM and then 1.5-3mg/kg q 72 hours.

– SE: Nephrotoxicity and ototoxicity.– Contraindications: Highly nephrotoxic,

give with SQ fluids. Don’t use in pregnant or geriatric patients or those that are dehydrated, shocky or have kidney disease.

– MOA: Inhibits protein synthesis.• Gram negative.• Bactericidal.

• Ceftazidime (Fortaz)– 20mg/kg IM or IV q 72 hours.– SE: Hypersensitivity, suprainfection,

anorexia, vomiting, and diarrhea.– Contraindications: Don’t give to pregnant,

young or lactating animals.– MOA: Inhibits cell wall synthesis.

• Broad spectrum.• Bactericidal.

Antibiotics• Enrofloxacin (Baytril)

– 7.5-10mg/kg IM, SQ or PO SID for 7-21 days.

– SE: Diarrhea, fatigue, and lethargy.

– Contraindications: Give in front legs ONLY. Should not be used in young animals.

– MOA: Inhibits bacterial DNA gyrase.• Broad spectrum.• Bactericidal.

• Trimethoprim sulfadiazine (Tribrissen)– 15-25mg/kg IM SID for 7-14 days– SE: Dry eye (KCS), hepatitis, vomiting,

inappetance, diarrhea, fever, skin rashes and facial swelling.

– Contraindications: Don’t use in pregnant or lactating animals.

– MOA: Inhibits synthesis of folic acid.• Broad spectrum.• Bacteriostatic.

Additional Treatment• If the turtle won’t eat, feed via syringe or

stomach tube (1.5ml/100g).– Turtle Gruel Recipe:• Small jar pureed chicken baby food• Small jar pureed green beans baby food• ½ - 1 cup of Pedialite• ¼ tsp cod liver oil• 1tbsp calcium powder

Prognosis• If handled properly and

treated in a timely manner, the prognosis is good.

• Before placing the turtle in water or releasing (if wild), be sure the shell is completely sealed.– The healed area can be

sprayed with vegetable oil spray to help prevent debris from sticking, especially on plastron injuries.

Prevention• By far the greatest threat to the health and

well-being of turtles is the highway.• If it is safe to reach the turtle, take it to the

side of the road in the direction it was heading and release it.– If it is released back where it was headed from, it

will re-attempt to cross the road.• Be cautious when mowing the lawn or

handling any lawn equipment.

Client Education• There are several ways a turtle can injury its

shell.– Most commonly broken when hit by a car.

• Since turtles are long-lived, the turtle you are taking the time to care for could have many decades left to live.

• The broken shell should be treated as if it were lacerated skin, it protects the interior organs: both the tissue and body cavity must be treated before the shell is closed up.

Client Education Continued

• Cements or epoxy are meant for permanent shell replacement and are just as reliable as the turtle’s actual shell.

• The instructions provided are not intended to be a “do-it-yourself” manual but more of what to expect when taking the injured turtle to an experienced veterinarian for treatment.

References• http://www.anapsid.org• http://www.centralah.com• http://www.tortoisetrust.org• http://www.ahc.umn.edu• Merck Veterinary Manual• Personal experience• Wildlife Center of Texas

(Houston, TX)• Clinical Pharmacology and

Therapeutics for the Veterinary Technician 3rd edition