Repair of an Open Comminuted Calvarial Compression Fracture in a Juvenile Green Sea Turtle (Chelonia mydas)
Abstract
On June 25, 2012, a juvenile green sea turtle (Chelonia mydas) stranded on Holden Beach, NC and was admitted to the Karen Beasley Sea Turtle Rescue and Rehabilitation Center (KBSRRC) with massive head trauma, a left front flipper laceration, and left marginal carapace trauma. The turtle was referred to the North Carolina State University College of Veterinary Medicine Exotic Animal Medicine Service for computed tomography, ophthalmic consultation, and surgical stabilization of the skull fracture.
The computed tomography revealed a right-sided open comminuted compression fracture of the calvarium and fracture of the left metacarpal bone. The ophthalmology examination suggested possible bilateral corneal perforation with the right eye more severe than the left eye. A decision was made to stabilize and minimize the skull fracture surgically, using morphine for sedation and analgesia. The procedure was achieved using clothes fastener hooks (corset hooks), 26 gauge stainless steel wire, and epoxy. This technique has been previously described in chelonian shell repair.1 The lesion was debrided to remove caseous and necrotic debris. Prior to hook adhesion with Permatex clear epoxy (Permatex PermaPoxy Clear General Purpose Epoxy, Solon, Ohio, USA) the skull scute area was scored using an 18 gauge needle. A single figure eight 26 gauge wire was loosely wrapped around each pair of hooks. Epoxy putty was placed on each hook to protect it from water damage. Once the epoxy was dried, the wire was tightened to stabilize and minimize the fracture. Other lesser wounds along the carapace were debrided and covered with topical silver sulfadiazine (Thermazene, The Kendall Company, Mansfield, Massachusetts, USA). The left metacarpal bone fracture was left to heal via supportive care.
For post-operative management, the turtle received ketoprofen, ceftazidime, topical silver sulfadiazine, and ciprofloxacin ophthalmic solution. The turtle was returned to the KBSRRC, where it continues rehabilitation, and has not displayed neurological signs despite CNS exposure to the aquatic environment prior to rescue. The skull fracture has healed well and the turtle is visual in the left eye.
Acknowledgements
The authors thank the staff and all the volunteers at the Karen Beasley Sea Turtle Rescue and Rehabilitation Center and the North Carolina State University - College of Veterinary Medicine (NCSU-CVM) Anesthesia service, especially Dr. Lysa Posner and Dr. Kate Bailey. We also thank the NCSU-CVM Turtle Team and the ophthalmology and radiology services.
* Presenting author
Literature Cited
1. Bogard C, Innis C. 2008. A simple and inexpensive method of shell repair in Chelonia. J Herp Med Surg 18:12–13.