Case File on Darth

[Kapidolo Farms]

Darth, a wild caught studbooked male M.e.p. , was found in his enclosure not using his rear left leg properly. After a few observations it did not seem to self correct. Maybe what might be the popcorn kernel phenomena (for lack of a better POV) was ruled out. Two x-rays were taken and it appeared that left rear leg was dislocated from the hip. The vets in his close locale to Darth did not see an apparent remedy. So now he's living in Carlsbad with me.

I took him to Thomas Boyer* who did his own series of x-rays and found Darth's left upper rear leg bone dislocated from the hip. The ball of the upper leg bone was 'sorta' wedged between the hip and the inside of the carapace. For the x-ray and pre-surgery workup Darth was anesthetized. Dr. Boyer was then able to re-place the ball back in the joint. But it promptly fell out again. The nature of turtle hips and the length of time are factors indicating that the best possible outcome is to remove the ball joint and allow fibrous tissue to cushion the space between the top of the upper leg bone and the hip.

This type of surgery is only documented once in 'the literature' and it was done on a smallish leopard tortoise, where the surgery was done through the opening (arm/leg pit) in front of the affected rear leg. That leo was, as I recall, about ten pounds. Darh is a near 60 pound male, and so the volume of tissue to deal with and the angel of the work to be done will make the surgery onerous.

Dr Boyer is practicing a few routes and methods on cadaver tortoises to have kinetic knowledge of how to proceed. It has never been done on a tortoise this size before, and novel methods are in consideration.

Right now Darth is 'feeling no pain' while getting a prescribed pain relief med, his injured leg is not just dragging, but does not seem to help propel him either. He's in a new large plywood box so I can keep close tabs on him. He's eating up a storm, so that helps me sleep easier.

One fun anecdote, one of the 'techs' was wondering why he is called Darth, them he did his Star Wars sound effect and she figured it out.

Here is a link to a few seconds of Darth chowing down on 'Santa Barbara Mix' with some hay, Layena, and opuntia mixed in...https://www.dropbox.com/sh/n8rj9lnxih9lyxg/AABSFMCIAM6Sw7fa0JAeRynMa?dl=0

These are the initial x-rays...





Dr. Boyer is really go out there and pulling together a great deal of resources to make this right. The prognosis is unknown, but that Darth is getting the best care possible is for certain.

As more comes pass on this case I will post it here.

*Thomas H. Boyer, DVM
Pet Hospital of Penasquitos
9888 Carmel Mt. Road, Suite F
San Diego, CA 92129
Tel: (858) 484-3490
Fax: (858) 484-3499

 

[Yvonne G]

Thank you, Will. This is all very interesting. Nothing seems to faze those darned Manouria tortoises, huh? Any other tortoise would be sulking and not eating.

So, you're saying he's not holding his leg deep up inside anymore, but dragging it? Hm.

Is there a reason you don't have substrate in the box? (Just curious)

 

[Momof4]

Thanks for the update Will! I know Darth is in good hands, Dr. boyer is my vet too.

 

[leigti]

I am just throwing this out there, I'm not a vet but I've worked with a lot of people with hip surgeries been done. It takes time for that fibrous tissue to form. He is a heavy tortoise and just letting that leg drag won't work. But if you tie it up into one position until it does form it will freeze up that way which will also make him l less functional. There have been several threads on some smaller tortoises who had a leg removed and people used different objects to keep them up off the ground. Maybe something like one of those little square four wheeled scooters could be put under him and then attached to him with a strap or something. That would keep him off the ground but he could still use his legs to propel himself. I know this sounds crazy but I'm just thinking of something to keep him moving until that joint can heal up the way it is intended to. I hope the vet doesn't fall over laughing reading this I mean it with all good intentions.

 

[Kapidolo Farms]

Thank you, Will. This is all very interesting. Nothing seems to faze those darned Manouria tortoises, huh? Any other tortoise would be sulking and not eating.

So, you're saying he's not holding his leg deep up inside anymore, but dragging it? Hm.

Is there a reason you don't have substrate in the box? (Just curious)

@Yvonne G, he pulls it in then pushes it out as he moves about, but I do not believe he is 'pushing forward' with that leg. No substrate to keep it simple right now. Depending on what and how the surgery goes, substrate may be to 'dirty'. @leigti, I'll talk that out with the vet. I agree that the leg should not be held still or the muscles might wither away. Dr. Boyer, he's probably got something figured out. I will make a point of the leg exercise though. Maybe lots of PT.

 

[Yvonne G]

Maybe when the time comes you can figure out some sort of sling that keeps him suspended in water, but off the bottom...hydro-therapy??

 

[leigti]

He just need something to keep that leg from getting stuck under him or he will pull it all apart again. And hydrotherapy would be great.

 

[Tidgy's Dad]

This is how science expands its frontiers.
Very interesting.
And I hope very much Darth makes as much of a full recovery as is possible for him.
He sounds like quite a character.

 

[Kapidolo Farms]

He just need something to keep that leg from getting stuck under him or he will pull it all apart again. And hydrotherapy would be great.

I'm not sure I get the concern. His left rear leg is not currently strong enough to lift him, then have him slide backwards to step/lay on his own leg. He pushes the leg out straight back in coordination with his other legs as when walking, then pulls it in, as in coordination with walking. The left rear portion of his plastron does not lift from the substrate he is walking on. When he is under the heat source ( three 45 watt floods) he does push that left rear leg much further out in the typical basking pose. When I disturb him by lifting the top such that he detects me spying on him, the left rear leg pulls in as much as the right rear leg. I do not believe there is a way for him to get his leg stuck under himself.

 

[leigti]

I'm not sure I get the concern. His left rear leg is not currently strong enough to lift him, then have him slide backwards to step/lay on his own leg. He pushes the leg out straight back in coordination with his other legs as when walking, then pulls it in, as in coordination with walking. The left rear portion of his plastron does not lift from the substrate he is walking on. When he is under the heat source ( three 45 watt floods) he does push that left rear leg much further out in the typical basking pose. When I disturb him by lifting the top such that he detects me spying on him, the left rear leg pulls in as much as the right rear leg. I do not believe there is a way for him to get his leg stuck under himself.

I meant more after the surgery. During the healing time. I'm sure he will probably be fine, just want to minimize the chance of complications.

 

[tortadise]

I'm seeing some odd wear on the ball for sure. Kinda looks like the ischium is worn weird too. What's the plan of attack here. Prosthetic implant? Definitely sucks this happened.

 

[leigti]

I'm seeing some odd wear on the ball for sure. Kinda looks like the ischium is worn weird too. What's the plan of attack here. Prosthetic implant? Definitely sucks this happened.

I think they plan to take the joint out. Then let scar tissue form.

 

[tortadise]

I think they plan to take the joint out. Then let scar tissue form.

Geeze. I know they have made some great breakthroughs with hip displasia in canines, I wonder if this could be a possibility in this scenario. Depending on what is found upon opening the animal. I'd speculate a good amount of exploratory will be undergone ounce the procedure commences. Has amputation been ruled into a possibility? I'd imagine an amputation would prove a much more rapid recovery procedure than scar tissue and use(or as best of use) of limb.

 

[leigti]

Geeze. I know they have made some great breakthroughs with hip displasia in canines, I wonder if this could be a possibility in this scenario. Depending on what is found upon opening the animal. I'd speculate a good amount of exploratory will be undergone ounce the procedure commences. Has amputation been ruled into a possibility? I'd imagine an amputation would prove a much more rapid recovery procedure than scar tissue and use(or as best of use) of limb.

I wondered about hip replacement or amputation also. People have a hard time recovering from the false joint approach, a 60 pound tortoise I think would have an even harder time. But I guess that is very good and he is probably thought of both of these things. @Will

 

[Kapidolo Farms]

Dr. Boyer looked to the literature, there is only one case reported for tortoises. He called and spoke with essentially all who might have done this and not published. He is practicing on large deceased individuals - several routes and procedures. All things are in consideration.

We will see what comes, as it comes.

 

[Kapidolo Farms]

Darth had surgery yesterday April 17, today when I picked him up at the vet's office he was fully awake and even a bit feisty. When transporting him I put sometime over him to block out most light. He wouldn't have it on the trip back from the vet office.

Dr. Boyer elected to enter and remove the ball of the leg bone through the area just in front of the leg itself. He reported the other routes suggested by peers were not at all acceptable, so he followed the example in the write up about the leopard. The ball is huge, image attached.

A peg has been attached to his plastron to lift the area above the surgery-ed leg. I spent awhile watching, he relaxes his leg, it slowly extends, then when it touches the box bottom he pulls it back in, so provoking motion to keep the muscles working and scar tissue developing seems to be built into the point of the peg as well. A gentle touch and Darth is okay with me sorta massaging his leg. Tricky business for sure, if he jerks his leg in he could tear my finger tips off. Those leg scales are gnarly.

I have an antibiotic injection every three days and oral pain meds daily for him. Up to the time I took him in for surgery he was showing no hesitation to eat. I have a variety of good things for him to eat and will see later today his propensity to eat.

So this is the ball joint ball...

 

[Kapidolo Farms]

FYI this is that leopard article citation.

Adam D. Naylor (2013) FEMORAL HEAD AND NECK EXCISION ARTHROPLASTY IN A LEOPARD TORTOISE (STIGMOCHELYS PARDALIS). Journal of Zoo and Wildlife Medicine: December 2013, Vol. 44, No. 4, pp. 982-989.



CASE SERIES/REPORTS
FEMORAL HEAD AND NECK EXCISION ARTHROPLASTY IN A LEOPARD TORTOISE (STIGMOCHELYS PARDALIS)
Adam D.Naylor, B.Vet.Med., M.Sc.W.A.H., Cert. A.V.P., M.R.C.V.S.
Abstract: 
Cases of femoral head and neck excision arthroplasty are infrequently reported in reptiles, and details of surgical technique and clinical outcome in chelonia are lacking. An adult female leopard tortoise (Stigmochelys pardalis) was presented with chronic non–weight-bearing lameness of the left hind limb. Examination and radiography were consistent with coxofemoral luxation, and as a result of the chronic presentation, surgical intervention was recommended. A cranial approach to the joint via the prefemoral fossa afforded good surgical exposure. A depressed lytic acetabular lesion was noted during the procedure, postulated to be a result of abnormal wear from the luxated femoral head. A fiberglass prop was used during recovery to allow extension of the limb without full weight-bearing. Lameness persisted postoperatively, but limb usage significantly improved.


Key words: Arthroplasty, coxofemoral, Stigmochelys pardalis, leopard tortoise, luxation

Received: March 19, 2012

 

[leigti]

That's good news. I'm glad the vet did something to keep that part of him up a little bit off the floor. And it still lets him move that leg. Can you take a picture of that peg? I guess it's the physical therapy in me, it just interests me.

 

[Kapidolo Farms]

That's good news. I'm glad the vet did something to keep that part of him up a little bit off the floor. And it still lets him move that leg. Can you take a picture of that peg? I guess it's the physical therapy in me, it just interests me.

Yeah I will on Monday when I fool with him to give him a shot.

 

[Yvonne G]

I really feel bad about this. Darth was our only breeding male for this group. I feel that his breeding days are now numbered. Those girls are so big and strong and now he's an invalid. Of course, I feel bad for Darth, but the tortoise-keeper in me pines for the breeding aspect of it.