1) Injuries to the Shoulder Girdle
For most defects affecting the shoulder girdle, the prognosis is hopeless and no therapy is possible. Clinically, shoulder girdle defects almost always show asymmetry of the shoulder area: One shoulder "hangs" significantly lower than the opposite side, the tip of the corresponding wing stands higher than the other. When the swift is placed on its back as a test, it cannot turn itself back over on its own (rotation test).
Coracoid fractures are a common result of accidents in adult swifts; flight capability can rarely be restored. Due to mostly moderate to severe displacement of the fracture ends, there is also injury to surrounding soft tissue, often including the lungs, with peracute dyspnoea and bleeding from the beak occurring. Immobilisation of the patient can lead to healing of the fracture, but shortening and altered statics of the shoulder girdle are almost always the result. This would allow a bird not dependent on good flight ability to survive, but not a swift (rare exceptions confirm the rule; in isolated cases, a coracoid fracture heals without displacement, asymmetric wing movements and visibly impaired flight ability are not observed, and after extensive physiotherapy a successful release can follow). Surgical treatment of the coracoid through intramedullary pinning is not possible, as the short, strong and difficult to access bone is covered by extensive muscle tracts and access without significant soft tissue injury is not possible.
Wishbone fractures are also hopeless. Experience has shown that immobilisation is unsuccessful in all cases, surgical treatment is not possible, as the clavicle as a delicate tension spring construction cannot be stably fixed. There is always displacement and irreversible loss of function.
Scapula fractures can be healed in a few favourable cases when the fracture ends are only slightly displaced, lie parallel to the ribcage, and the affected swift tolerates absolute cage rest. However, if one fracture end points ventrally and there was severe displacement, extensive callus formation occurs, and the affected swifts remain lame and do not regain their flight ability. Presumably, strong pressure or adhesions of the callus tissue with the ribcage lead to considerable movement restriction.
All dislocations and subluxations in the shoulder girdle area are hopeless and reason for immediate euthanasia. Every ligament tear leads to loss of function and subsequent stiffening of the affected joint. Flight ability has never been regained in any swift.
The situation is different with closed soft tissue trauma (contusion). The clinical picture with severe lameness and loss of function can simulate a defect of the bony locomotor system, especially since the injured swift cannot turn itself over from supine position on its own (rotation test). However, if no defect is radiologically detectable, one can assume a contusion; the prognosis is doubtful to favourable. In a few cases, severe contusion leads to stiffening of the involved joint and permanent loss of flight ability. Usually, however, only 8-10 days of cage rest are required until the bird gradually begins to move the affected wing again. With daily physiotherapy including passive stretching and moving of the wing, massages, then movement exercises in a curtain and finally flight exercises in a suitable training room hung with curtains, flight ability is restored within two to six weeks. Without sufficient daily exercises, however, progressive regression and increasing stiffening of the wing occur. A manifest contracture in the shoulder joint cannot be reversed, and euthanasia is then unavoidable.
2) Wing Injuries
The prognosis for wing fractures depends on location, age and extent of the damage. Humerus fractures cannot be treated. Conservative fracture treatment leads to shortening and contractures in the shoulder and/or elbow joint. Surgical intervention is not possible because the short humerus lies proximally under extensive muscle tracts and does not allow access. Its dorsal condyle is so narrow and close to the elbow joint that, unlike in other bird species, even with maximum flexion, exit of an intramedullary pin without affecting and later ankylosis of the joint would not be possible.
Prognostically more favourable are forearm fractures. In swifts, surgical or conservative treatment of radius or ulna fractures should not be fundamentally preferred. Advantages and disadvantages must be weighed case by case; especially in the forelimb area, X-ray images in both standard planes are essential! Surgical approaches and operating techniques as well as special bandages for birds (e.g. figure-eight bandage) are well described (GYLSTORFF and GRIMM, 1987; OROSZ et al., 1992; MARTIN and RITCHIE, 1994; BENNETT, 1997; McCLUGGAGE, 1997) and applicable to swifts in almost all cases. Certain problems in surgical treatment of forearm fractures result from the shortness of the upper arm and thus from obstruction by the body when repositioning fractures and positioning the intramedullary pin. There is also increased risk of contractures even from minor joint involvement. Subluxations can easily occur during reduction of the fracture ends, particularly in the radiocarpal and humeroradial joints. The intramedullary pinning of forearm fractures, which is relatively uncomplicated in other larger birds, is therefore associated with certain risks in swifts.
Radius fractures are almost always closed. Clinically, there is no wing asymmetry, but unilateral lameness and usually a haematoma on the inner wing surface. If the fracture ends are severely displaced and no longer in contact, intramedullary pinning is necessary to restore complete flight ability. The pin, appropriately a 0.4 mm cannula, exits from the free distal radius end at the radiocarpal joint with the carpal joint maximally flexed, is cut off 2 mm above the skin and left for 10 days. With only slight displacement, cage rest can lead to satisfactory bone healing. However, it should be noted that in a fresh fracture, an extensive haematoma may temporarily hold the fracture ends in position, which can still shift considerably against each other after resorption. Applying a bandage is unnecessary for radius fractures, as the intact ulna acts as a natural splint.
For ulna fractures, surgical treatment by intramedullary pinning (a 0.5 mm cannula is suitable) is usually necessary, as otherwise considerable shortening and extensive callus formation can occur and complete restoration of flight ability is not given. However, due to the joint involvement caused by the exiting intramedullary pin, there is a risk of ankylosis and later lameness.
With only slight displacement of the fracture pieces, it should therefore be considered whether conservative treatment does not represent the lesser risk. This requires immobilisation under bandage for approximately 10-12 days. Subsequently, several weeks of convalescence with intensive daily physiotherapy is necessary to regain satisfactory flight ability, as the immobilised joints stiffen very quickly under bandage.
Particularly complicated and often not satisfactorily treatable are radius-ulna fractures, which can already be clinically diagnosed immediately by crepitation, strong haematoma formation, free mobility at the fracture site and asymmetric wing posture (wing "hangs down"). For open fractures of 2nd and 3rd degree, comminuted and shattered fractures, no attempt at surgical treatment should be made due to the poor prognosis, but the bird should be euthanised. Furthermore, it must be clarified whether, in addition to the obviously visible fracture, there may also be a dislocation that would negate any attempt at therapy from the outset.
If the prognosis is doubtful to favourable, surgical treatment is indispensable. Satisfactory reduction is only possible through intramedullary pinning and additional application of a suitable bandage (figure-eight bandage) for a few days. The intramedullary pins are cut off 2 mm above the skin and left for 12-14 days. The radius pin exits at the carpal joint, the ulna at the elbow joint, and can be removed without further anaesthesia if the fracture is stable. Complications can unfortunately occur relatively frequently when adequate immobilisation of the fracture is not achieved even under bandage and shear forces act on the fracture ends, and when the exiting intramedullary pins lead to joint involvement, particularly in the elbow joint, which can result in later movement restriction. Fitness for release may then no longer be achievable.
Metacarpal fractures usually have a hopeless prognosis, as they are almost always open comminuted fractures with severe injury, tearing and contamination of the surrounding soft tissue. Experience shows that with such 2nd and 3rd degree fractures, even with immediate wound treatment under general anaesthesia and bandaging, flight ability is not regained.
Only with fresh simple fractures, closed or open 1st degree, therapy is almost always successful. A careful decision must be made between immobilisation using a figure-eight bandage - which must always be performed under general anaesthesia to cleanly reduce the fracture ends, suture any wounds and apply the bandage with padded splint accurately! - and a surgical intervention in the form of intramedullary pinning.
At the Swift Station, treatment with splint and bandage is preferred because it has been proven that the healing process is faster and less complicated than with surgery. If surgery is still indicated, access for closed fractures is from medial, for open fractures at the wound site. A precisely cut, sterile piece of fibreglass is inserted into the medullary cavity of the carpus with maximum flexion of both fracture ends and care for the surrounding fine tissue. The fracture ends are pushed together over the intramedullary pin, the wound area is flushed, and the skin wound is closed with interrupted sutures. A figure-eight bandage is applied for 10 days. Bone-penetrating antibiotic therapy to prevent osteomyelitis (e.g. Clindamycin) is advisable. The pin remains in the medullary cavity. BENNETT (1997) points out the possibility of leaving a bone implant if it cannot be removed after the fracture has healed. Fibreglass implants are not mentioned in the literature but have already been tested in individual cases (N. KUMMERFELD, unpubl. comm., 2003).
In birds, polyethylene and polymethyl methacrylate implants are also used, which can likewise be left in the medullary cavity (MARTIN and RITCHIE, 1994). The application of this material is not yet possible in swifts, as no implants of the required small diameter (0.8-1.2 mm) are available, whereas fibreglass rods can be filed to fit. Plate osteosynthesis and external fixation are not applicable in swifts, as the bony structures are too small.
Finger fractures are very rare. At the Swift Station, a simple fracture of the distal phalanx of the major digit was successfully treated conservatively with a narrow bandage that fixed the finger to the quills of the 7th and 8th primary feathers; a figure-eight bandage was not necessary.
After healing of a conservatively or surgically treated wing fracture, intensive daily physiotherapy is absolutely necessary, not only to regain full functionality of the wing, but also to prevent inactivity atrophy of the flight muscles. After radius fractures, full flight ability is usually restored after approximately 3 weeks; with radius-ulna and hand fractures, it can take 4 to 6 weeks.
Dislocations and subluxations of the wing joints are hopeless in all cases in swifts and an indication for euthanasia. They inevitably lead to contractures and thus to loss of flight ability.
Soft tissue trauma must be assessed case by case according to the extent of damage. Smaller, superficial lacerations and abrasions have a favourable prognosis with proper wound treatment, provided there is no injury to underlying nerves and tendons. Even seemingly insignificant lacerations should be sutured to prevent further tearing of the skin and drying out of soft tissue. For deeper wounds, careful evaluation under general anaesthesia is needed to determine how far the underlying tissue and also the quills of the primaries and secondaries are affected. Often only after wound debridement and healing of the injuries can it be assessed whether the functionality of the wing is preserved. Scalping wounds, in which not only skin portions but also feather follicles have been destroyed, have proven hopeless. With more than one missing primary per wing, a swift can no longer be classified as fit for release.
Soft tissue trauma of the wing is not infrequently associated with severe damage to one or more primaries. The feathers may be bent or broken. Pulling a damaged primary is strongly discouraged, as there are very often considerable disturbances in the growth of a new feather afterwards, or no feather is pushed out at all. Traumatic or mechanically caused large feather damage should always be remedied by the falconry method of imping, which has proven successful in all cases so far.
Previously observed degenerative or presumably metabolically caused changes in the wing skeleton usually had a doubtful prognosis but must be assessed based on the picture the affected bird presents over several weeks during physiotherapy and flight training. If dystrophic changes of joint surfaces are present, the prognosis is hopeless. With curvatures of long tubular bones, which have occurred multiple times in the radius and carpometacarpus, most affected young swifts show such good flight ability that it seems justified to release them under observation.
For clinical pictures suggesting paralysis, one should wait and the bird should receive physiotherapy several times daily for several weeks. A young bird with unilateral wing paralysis after intramuscular injection in the breast muscle was only able to fly again after 8 weeks of intensive training.
3) Injuries to the Body
Fractures in the body area are rare. Since they can be serious and may be difficult to diagnose under certain circumstances, the body skeleton should be examined particularly carefully radiologically, especially in cases of unexplained flight inability, dyspnoea and tachycardia. Complete sternum fractures may not be noticed initially during clinical examination, but affected swifts do show the above-mentioned symptoms. Only radiological examination in ventro-dorsal and latero-lateral projection shows a displacement in the line of the carina sterni when the breastbone keel and sternum are fractured transversely. This results not only in flight inability, particularly due to instability of the body skeleton, but above all, with every movement of the bird, pressure of the fractured sternum on the immediately adjacent heart and displacement of heart and liver dorsally. Due to severe general disturbance, such patients must be euthanised.
In one case of an incomplete sternum fracture with severely displaced tear in the carina sterni, surgical repositioning was successful at the Swift Station. The swift regained full flight ability after several weeks of physiotherapy and could be released. A multiple rib fracture was once observed as a result of a cat bite. Despite immediate surgical wound treatment, the adult swift could not be saved.
For soft tissue trauma, the same conditions apply as listed in the "Wing Injuries" section. Any tear, no matter how small, should be properly treated and sutured, as the skin over the massive pectoral muscles is very tight and can easily tear further, while in the back area even harmless-looking injuries can affect the ribs and underlying lungs because the skin is very thin and there is no protection from other soft tissue.
4) Injuries to the Hind Limbs
For fractures and dislocations of the hind limbs, the prognosis is usually favourable. Unlike many other bird species, functional impairment or even loss of a hind limb presumably does not jeopardise the survival of a swift in the wild. In fact, even one-legged swifts manage for years in the wild (E. KAISER, unpubl. comm., 2001).
Simple and double leg fractures – usually the tibiotarsus is affected – occur very frequently when very young swifts fall from the nest, when the nestling is still largely unfeathered and at the same time well-nourished, i.e. heavy, and cannot yet cushion the fall with its large feathers. Adult birds, on the other hand, often get their feet caught in threads at the nesting site or while searching for a nesting site and hang helplessly from the roof. If they are rescued, strangulated, dislocated and fractured hind limbs are the result. An X-ray is usually not necessary for diagnosis and therapy; clinical examination is usually sufficient for further action.
In complicated comminuted fractures, multiple dislocations and necrosis after strangulation, the affected leg should be amputated. Disarticulation at the knee or intertarsal joint has proven successful. The considerably stronger leg musculature of an adult swift compared to a young swift must be taken into account; profuse bleeding can occur if muscles and vessels are not carefully ligated.
For uncomplicated tibiotarsus fractures, short-term fixation with a body bandage ("body wrap") is successful in most cases. Fractures in nestlings usually heal after just a few days. Any displacement and minor malposition of the foot are to be tolerated.
Pododermatitis, usually secondary findings, occasionally self-inflicted through injuries from their own claws, have proven to be complicated and largely therapy-resistant in swifts. Medical treatment as well as surgical opening of the footpad abscesses remain largely unsuccessful. Only in a few cases of malnourished young swifts were purulent abscesses present; in affected adult swifts, there were rather diffuse swellings of the soft tissue. Since a prolonged inpatient stay appeared contraindicated due to the increased stress to which the swift's feet are exposed through the lying body position, the affected adult birds were released after healing of their primary defects.
5) Injuries to the Head and Neck
Relatively frequently, swifts have lower beak fractures. Adult birds are less commonly affected, where the injury occasionally occurs as a result of an accident after a collision. It must first be clarified whether there are other, more serious injuries with a hopeless prognosis before considering treatment of a beak fracture. In young swifts - found birds in human care - a beak fracture is mainly caused by carelessness during forceful feeding of the bird being cared for. When opening the beak, the delicate rostral tip of the mandible is bent off, often bilaterally. If it is a fresh, uncomplicated fracture and the horny sheath of the beak is intact, it usually heals without further treatment within a few days, provided that opening of the beak for feeding is henceforth done with utmost care and proximal to the fracture. If there is an open fracture with displacement of the fracture ends, wound toilet and application of a splint are advisable. Treatment should be carried out under general anaesthesia if necessary, to accurately place the splint. A longitudinally cut piece of feather quill, e.g. from a pigeon, which is slid over the fracture site, has proven successful. The splint can slip off when callus forms underneath and a bulge develops. However, by then sufficient stability has usually been achieved. In complicated accident-related fractures, surgical stabilisation with cerclages of absorbable suture material and subsequent immobilisation was also successful in individual cases. Feeding was done from the other side of the beak with minimal opening of the mouth. In this process, the lower beak was not pulled down as usual, but the upper beak was pulled up.
Fractures or dislocations of the hyoid bone can also be caused by carelessness during feeding by laypeople. Such injuries to the apparatus hyobranchialis can occur when the tongue is accidentally forcibly bent backwards into the throat while inserting food insects. Severe recurring swallowing and breathing difficulties, at worst suffocation, are the result. Sometimes the defect heals so that the affected bird can live without complaints. However, if permanent dyspnoea and/or dislocation of the tongue remains, it must be euthanised.
A radiologically documented skull fracture was fatal: The adult swift with a fissure of the occipital bone and a severe eye injury did reach the Swift Station still alive, but was immediately euthanised due to severe general disturbance. It was bleeding from the ear, pathognomonic for a skull base fracture.
Eye injuries have a poor prognosis in swifts. Usually severe collisions are the cause, leading to irreversible and extremely painful damage such as lens rupture, bleeding into the anterior chamber of the eye, increase in intraocular pressure and corneal defects. While extirpation of a destroyed eye is possible in pet birds, a swift with only one eye is not fit for release. Halving of the visual field, loss of sectoral spatial vision would impair target orientation and thus also food acquisition so much that survival is impossible. Swifts with irreversible eye injuries must be euthanised. If this cannot be done immediately, adequate analgesia (local and systemic) must urgently be provided!
Eye involvement can also be caused by foreign bodies, e.g. stuck feathers that poke the eye and cause irritation, at worst corneal lesions. Successful treatment is possible in many cases, but an eye specialist should be consulted. Antibiotic eye drops are not (always) sufficient; sometimes smoothing of the cornea under local anaesthesia is necessary. Complications are not uncommon. Never thoughtlessly apply corticoids locally; in perforating corneal injuries, they can provoke the development of an ulcer!
Soft tissue trauma in the head area included scalping wounds, e.g. from grazing wires in flight, as well as secondary injuries from a predator, e.g. from a magpie, when the swift had gone down after a collision. Depending on the extent and depth of the wound, wound treatment must be carried out immediately, possibly under general anaesthesia. If parts of the skull are exposed, care must be taken to keep the wound moist until the defect can be closed and wound suturing can be performed. Injuries in the throat and neck area can be impalement or laceration wounds, as in the case of an adult swift that grazed a nail with a full throat sac. The throat was perforated from the rostral tip of the lower beak to the base of the neck. Immediate surgical wound treatment and application of a double suture were successful.