Abstract Introduction
The Asian elephant (Elephas maximus) is threatened with extinction mainly because of conflict with human activities.2,13 Half of the world’s remaining Asian elephants share the present range of 20% of the world’s human population.13 Mahouts are decreasing in number and aging.3 Zoos may become the sole repository of the species. Much effort is invested in the breeding of Asian elephants. Peri-natal injuries by the mother are not uncommon in captive animals.11 This report describes the successful management of an oblique midshaft humeral fracture in a neonate Asian elephant calf at the Night Safari, Singapore.
Case History
On the 18th April 1998 a newly born female calf weighing 108 kg was found unable to stand. The left shoulder was swollen and crepitus could be felt. An oblique midshaft fracture of the humerus with approximately 10 cm overlapping of distal and proximal fragments was diagnosed on X-rays. Myoglobinuria due to the injured muscles of the foreleg persisted for 48 hr.
An intravenous catheter was inserted in an ear vein. Fluid therapy was initiated alternating Ringers® and Dextrose 5%® (Thai Otsuka Pharm. Co., Thailand) at 50 ml/kg/day for a total of 9 L in 48 hr. Her rectal temperature was 39.8°C (normal 36 to 37).6 To accelerate heat loss the animal was maintained with wet and ice packs positioned between the limbs. The rectal temperature dropped to 38°C in 24 hr and remained in that region for the next 5 mo.
Serum from the mother (65 ml) was injected subcutaneously. oxytocin 100 IU were administered to the mother to assist milking. Warm colostrum (800 ml) was administered to the calf via a stomach tube.
Amoxycillin 1,650 mg (Betamox LA, Norbrook Laboratories) was injected intra-muscular every 48 hr for four treatments preventively. Flunixin 1 mg/kg i.m. (Flunixil®, Troy Laboratories) was administered for analgesia.
A custom-made modified Thomas splint was manufactured. The calf was supported in a sling for approximately 10 hr per day. The remaining time the animal was recumbent laterally on a padded area.
After 1 mo of trial and error with various formulas, a diet inspired from Mikota, et al.8 was selected. It consists of the following:
- UHT cow’s milk in boiled water 1:1, progressively concentrated to pure cow’s milk over 2 wk
- Vit C 0.5 g/L of milk
- Pediatric re-hydration solution (Repalyte®, Drug house of Australia) 4 g/L of milk
- Calcium carbonate powder 1 g/L of milk
The formula was offered every 3 hr and uptake was recorded.
After 3 mo in the sling the leg felt strong. It could not be ascertained on radiographs whether the fracture had healed satisfactorily. An equine veterinarian from the Singapore Turf Club and an orthopaedic human specialist were consulted. Plans for a surgical exploration of the fracture site were made.
The left leg was scrubbed twice daily for 3 days before the surgery. The calf was transported to the Singapore Turf Club equine Hospital on the 31st July 1998. Xylazine 0.08 mg/kg i.m. (Ilium Xylazine®, Troy Laboratories)1,8,12 was followed 20 min later by induction with ketamine i.v. to desired effect (1.15 mg/kg). A 16-mm cuffed endotracheal tube was passed and anaesthesia maintained with halothane 1 to 1.5%. Phenylbutazone (150 mg; Tomanol®, Vet Schering-Plough) was given i.v. preoperatively. Ringers solution was administered at a rate of 5 ml/kg/hr.
A 30-cm incision was made laterally, from the shoulder joint to the elbow. The fracture site was exposed by dissection of the arm muscles. The overlapping fragments were firmly joined by their extremities. A 1-cm gap between the fragments was filled with thick fibrous tissue. The fibrous bridge was curetted and the periosteum elevated. The fragments were adjoined using three compression screws. After recovery the calf was placed back in the sling.
Physiotherapy was started 2 wk after surgery in the form of swimming and walking in a large pool. The duration of exercise was increased gradually from 20 min to several hours per day. After 8 wk of physiotherapy she was allowed to ambulate freely. The right foreleg arched outwards to compensate for the shorter length of the left foreleg. By the age of 13 mo the two legs were of the same length.
Discussion
Several successful fracture cases in elephants are reported.8-10 In elephant the scapula and humerus are straight.5,12 Thomas splint are particularly well suited for the treatment of vertical bones.4,8,14 A Thomas splint was custom-made to fit the anatomy of the elephant. Two metal rings were connected by three metal rods. The proximal ring was angled such that it rested on the sternum and enclosed the shoulder laterally. A Robert-Jones bandage protected the limb. Muraleedharan Nair, et al. (2002).9 later reported the successful treatment of two cases involving fractures of the tibia and radius and ulna using a similar contraption.
Internal fixation of the fracture immediately after birth was complicated by the incompletely mineralised state of the neo-natal bone and by the considerable swelling of the surrounding tissues. The priority was to confer passive immunity and to keep the calf alive. Many milk formulas have been tried with varying degrees of success.7,8,11,17 The mother’s milk changes with the stage of lactation.15 Mercy (2002)7 reported that cow’s milk causes severe diarrhea. The diet used at the Night Safari and described above produced satisfactory results. It has been used since to raise three other calves.
Good quality radiographs of the humerus proved difficult to obtain due to the thickness and density of the tissues and the difficulty of consistent positioning of the animal. The consulting specialists feared a non-union. The animal was in good health and a surgical exploration of the fracture site was decided. With the benefit of hindsight, the surgical intervention appears unnecessary, but so was running the risk of a re-fracture. The procedure lasted 50 min. Anaesthesia was unremarkable and after reversal with yohimbine at 0.125 mg/kg i.v. the calf regained consciousness.
Physiotherapy was important, as the animal had never walked until the age of 18 wk. Physical re-education was carried out in water to reduce the weight borne while allowing a natural and full range of movements. Swimming is a mild and complete exercise that comes natural to elephants.1
Conclusion
The overall cost of the treatment from birth was calculated to be in excess of US $40,000, including manpower. The successful outcome of this case was the result of the collective commitment within the organisation. In zoological medicine inter-departmental collaboration and communication make the difference between failure and success.14
Acknowledgments
We are grateful to Dr. Rod Richards and Dr. Ong Leong Boon for their assistance with the surgery and the elephant keepers for their nursing feat.
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