Treatment and Outcomes of Tusk Fractures in Managed African Savanna and Asian Elephants (Loxodonta africana and Elephas maximus) across Five Continents

Abstract

Elephant tusk fractures are a clinical challenge that can impact the overall health of the animal, particularly when they result in pulp exposure. An international survey was sent to veterinarians to understand individual fracture characteristics and management strategies as they relate to outcomes, with the goal of better informing treatment procedures. The data set consisted of 79 fractures from 64 elephants (including Asian and African males and females), 44.3% of which were Class III fractures with pulpal involvement. Of this subset, pulp canal exposures of >0.5 cm were 23.8-fold more likely to develop pulpitis than fractures with <0.5 cm exposed, though canal size did not impact healing versus extraction outcome. Odds ratios showed that treatments including endodontics were 12.0-fold more likely to heal than tusks treated exclusively with medical management, though no association was observed in reducing the risk of pulpitis. Further, pulpitis was 7.58-fold more likely to develop when tap water was used to rinse exposed pulpal tissue; a finding that merits further investigation. The use of endodontic treatment versus medical management alone was significantly associated with improved recovery outcomes (i.e., reduced risk of extraction) in tusk fractures with pulpal involvement.

Partial pulpectomy of a tusk fracture with pulp exposure in a North Sulawesi babirusa (Babyrousa celebensis)

“…In fractures where the pulp is exposed, a painful pulpitis cannot be excluded and such a condition might lead to a loss of the tusk or require tusk extraction. [7][8][9][10] Therefore, therapeutic intervention is strongly recommended, but descriptions of successful repair of tusk fractures in babirusa are scarce. There is only one case report where the preservation of a fractured tusk was achieved by closing the pulp cavity using a polyoxymethylene (POM) bolt, 7 but POM produces toxic formaldehyde gas when heated, mechanically abraded or exposed to radiation such as x-rays.…”

“…The type of tusk fractures may vary from simple or uncomplicated fractures (loss of dentin only, without pulp exposure) to complicated fractures (pulp exposure). In fractures where the pulp is exposed, a painful pulpitis cannot be excluded and such a condition might lead to a loss of the tusk or require tusk extraction 7–10 . Therefore, therapeutic intervention is strongly recommended, but descriptions of successful repair of tusk fractures in babirusa are scarce.…”