Terrapene carolina triunguis injury case (6-25-00)

Just yesterday I received an adult female three toed box turtle into the clinic from a good Samaritan student at Ole Miss.  The animal had been hit by a car probably a week or two prior and it's plastron was in several pieces. 

Naturally, the first assumption was that the animal was carrying eggs and looking for a place to lay when she was hit.  A quick radiograph confirmed this suspicion as well as reaffirming the severity of the plastronal injuries.

Because of the severity of the plastron lesions and the need to immobilize/sedate her to work on her, I decided that the best thing to do would be to get the eggs out first.  Leaving the eggs inside her would put additional pressure on her lungs when she was immobilized and I was more concerned with helping her through this than taking unnecessary anesthetic risks.  Hopefully the eggs will be good but even if they are not, a viable female 3 toed such as this will have dozens of reproductive years left when she recovers.

Egg Removal:

I prefer dosing with an injectable calcium approximately two hours before giving oxytocin, a hormone that induces egg laying.  Oxytocin in my experience is generally rather effective in inducing ovipositioning.  However, I have run into a number of animals in which it just doesn't have the desired effect.  In these animals, I tend to utilize vasotocin, a "more powerful" hormone.  Also, in animals that are ready to lay, the oxytocin generally works in a matter of 20 minutes or so for the first egg.  I've found that in animals that are not ready or are not given an appropriate area to lay that it may require several hours before laying occurs.   In this case, it took 6 hours before she laid her first which was followed by the other 3 in rapid succession.  Below is a picture of a radiograph taken shortly before I left work (if you look closely, you can see the first egg in the pelvic canal while the other 3 are moving downward as well (when I get time I'll put in arrows!)).  There is also a bad picture of the 4 eggs about to go into an incubator.

One step down, many more to go.

The cleanup:

The next step is to try to remove all of the crud and debris from all of the plastron fracture sites.  It is also time to debride the dead bone from the plastron as well as assess the attachment (and subsequent blood supply) that remains for each of the fractured pieces.  Naturally, the first step here is to sedate the animal.  I tend to utilize an IV combination of medetomidine and ketamine which has a reversal agent.  I've found this combination to be much safer and more effective than straight telazol or ketamine.  IV propofol is another good option for anesthetic agents.  If you have a few hours and plenty of money, an induction chamber with isofluorane is another way to go.

Once the animal has been anesthetized, flush and debride, debride and flush.  Not fun but essential nonetheless.

BEFORE (note the debris in the fracture sites):

AFTER (healthy pink tissue is the goal so that healing can occur):

Ok, now that that is done, what next?

This was an old wound (probably at least a week or two old) and there was grime deep inside the shell fracture sites so I cannot seal the fractures up at this point and make it look "pretty".  I need to maintain access to the sites so that I can continue to flush them out and try to encourage healing with various substances.   On the other hand, I don't want this poor animal wandering around with it's plastron in 8 pieces either.  What's the solution?