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

SIMPLE SUMMARY: When tusk fractures occur in elephants under managed care, they can expose the soft tissues and substantial blood supply of the tusk’s pulp. The management strategies and clinical consequences of those fractures vary immensely in both the literature and the collective experiences of elephant managers and clinicians. Outcomes have ranged from self-healing with conservative management to life-threatening systemic infection. A detailed survey requesting tusk fracture characteristics and subsequent management and outcomes was completed by elephant veterinarians globally. A larger pulp canal diameter at the time of fracture and the use of tap water in the course of treatment were associated with an increased risk of the development of an infected and inflamed pulp, meriting further investigation. Endodontic treatment of fractured tusks with pulp exposure was associated with a reduced risk of tusk extraction. These guidelines can aid elephant managers and clinicians in their clinical decision making surrounding these challenging events. 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.