Great Blue Heron #21-1045

Stories of wildlife rehabilitation through the lens of veterinary medicine told by Dr. Claire Peterson

When I arrived at CWC, I met my patient. A scraggly beast of a blue-gray bird with white fluff sprouting Bernie-Sanders-like out of his head and with a croaking, demanding voice that he was HUNGRY.

Warning: Graphic Content – Please use your discretion before reading the following blog.

Our 1,045th patient of 2021 was a bedraggled floof of stick limbs and a pointy beak attached to an impossibly elongated neck. This young Great Blue Heron (patient #21-1045) had traveled quite a long way to end up on my exam table around 7 pm on June 10th.

A few hours earlier, we received a call that someone found a young heron with a broken wing, yet the closest rehabilitation center did not have an available veterinarian with knowledge of orthopedic surgery. I agreed to take a look and give it a shot – since the injury looked old and was healing in the wrong direction, this wasn’t a wing that could be fixed with a bandage wrap alone. An old break that’s healing incorrectly is much more challenging than a fresh injury. Thankfully, a generous and kind-hearted staff member at the Oregon Coast Aquarium was willing to transport the baby several hours to us that night. I had already gone home for the day, but I had an hour or two to get some chores done before driving back to the wildlife center.

When I arrived at CWC, I met my patient. A scraggly beast of a blue-gray bird with white fluff sprouting Bernie-Sanders-like out of his head and with a croaking, demanding voice that he was HUNGRY. It’s hard to explain to a baby blue heron that he must fast before anesthesia and boy was he was upset about it. The bird appeared startling, with his spear-like beak and long legs made for wading in high water, all folded up in an impossible tangle of limbs and neck and half-grown feathers; but his personality was immediately endearing.

We knew we’d have to work hard to keep him wild if the wing was fixable, but we were up to the challenge.

Once on the exam table and his head safely covered with a towel to keep his exposure to humans at a minimum and decrease stress, I could see they weren’t kidding about the backward-appearing wing. His upper-most arm bone, the humerus, was fractured and completely twisted around 180 degrees. It’s difficult to explain, but you can see it in these pictures:

In this picture, the heron’s head is to the left and his tail to the right of the image. The top of his wing is facing normally, but after the twist the underside of the wing is visible and you can see the underside of his elbow. Following that to the right, you can see his wrist is pointing back towards his tail instead of towards his head. It was painful to even look at – I couldn’t imagine what the heron must be going through!

In this photo, you can also clearly see how young he was since all of his main feathers were growing in underneath that flakey white covering. These feathers are called “blood feathers,” since as they grow in, feathers are filled with blood. Once the feather is fully grown, it pinches off and the feather is no longer connected to an active blood supply (like the feathers you find on the ground that are hollow). While growing in, it’s important not to bump these feathers or break them, as they will bleed and it will mean the feather won’t grow in properly – limiting its use for flight.

After his exam, we gave the heron some powerful pain medications as a precursor to surgery and after about 20 minutes put him fully under anesthesia. Once the wing was relaxed, I could palpate the bone better. The break, although it looked alarming, was a relatively clean-cut break through the middle of the bone. These tend to be the easiest to fix as the farther away from the joint a break is, the better. It means I have more room to place pins to help stabilize and hold the bone still so it can heal.

The problem here, however, is that it was an old break. The bruising was nearly gone and the bone was already trying to heal in its newly twisted position. I estimated the fracture to be about a week old – if we essentially re-broke it and put it right, could we convince the bone to heal in its natural position again? And was there any permanent damage to the surrounding soft tissue (muscles, tendons, nerves, and blood vessels) that will prevent flight even if we can get to heal? There are always concerns with fractures like these, but young animals (and people!) heal very quickly since everything is still growing. I felt we had a good chance to put things straight (figuratively and literally) so we moved forward.

Once everything was prepped and I was able to start surgery, I carefully broke through the tissue formations that were holding the wing backward and put it back in place. I had to open up the break area surgically and carefully debrided the ends of the bones. Debriding is removing dead tissue or making an edge “fresh” again so it’s prepped to heal. This is important to do when suturing up old wounds or dealing with any injury that isn’t fresh.

Next, I placed a long, thick, metal pin inside the hollow bone called an intramedullary pin (since it sits within the medullary cavity of the center of the bone). This pin exited out the top of the wing just before the shoulder joint. From there, I bent the pin at a 90-degree angle (the reason for this will be explained in a minute). After that main pin is placed, the bone is held in a straight position like it should be naturally. However, the pieces can still rotate around that pin or be pulled away from each other. The more the pieces of the break can move, the less likely they’ll heal back together properly. The basic pillars of orthopedic surgery are to get the pieces of bone to stay together as still as possible while they heal. This will create a stronger healed area that will heal faster and more completely than if those pieces are allowed to wiggle around. It’s hard for the body to form a bridge if the two ends keep moving about! So to stop the bones from being able to rotate or pull apart, I placed a much smaller perpendicular pin through each end of the bone, forming a cross with the main large pin. This left three pins sticking out of the wing, which I attached with a blue plastic bar to hold them together. The structure by itself keeps the bone pieces together and rigid to allow it to heal quickly, without the need for any bandages. Bandages would cover the feathers that are growing in, which may lead to feather damage. This way, the heron could move his wing and hold it as he naturally would, and he’d be able to preen his feathers without a bulky bandage in the way. This whole contraption is called a tie-in external fixator and is considered by many (including myself) the preferred way to surgically repair the bones of birds with their unique anatomy.

In the post-surgery pictures, you can see the patient is hooked up to gas anesthesia and oxygen by a tube in his throat called an endotracheal tube. He is also hooked up to a monitor that allows us to monitor his heart rate, oxygen levels, breathing, and CO2 levels. I am happy to report he was very stable under anesthesia! The fixator is the blue plastic, and the white circles are where I’ve capped off the sharp ends of the pins (so no one gets poked by them).

I also drew you a little picture to try and explain it better as well: The purple is the big pin inside the bone that I bent at a right angle. The pink lines are the two smaller perpendicular pins. All three are attached by the blue plastic bar to hold the bones steady.

Before waking him up from anesthesia, I took a low-powered cold laser to run over the fracture site. Cold lasers use concentrated light rays to stimulate blood flow and healing in tissues. It’s not painful (I’ve had it done on me before!) and is safe to use while the patient is awake. Over the next several weeks, I would try to laser the fractured area about two times a week to help promote healing.

After our little fuzzy dinosaur of a patient woke up from anesthesia, the next part was the hardest part for me: waiting. In the interim, our patient was a champion eater and put on weight to the point he had to be moved to larger and larger ICU cages so he didn’t have to hunch over. During this time, he was on two different pain medications, an anti-inflammatory, and antibiotics to prevent infection in the healing area. He was on “staff only” handling during this time since we must be VERY careful when moving him in and out of his ICU kennel for cleaning so as not to bump the pins and pull them out of the wing too early.

During this time he became feistier and feistier, and harder to handle! This was an excellent indicator that we were doing our job as wildlife rehabilitators to keep a growing, impressionable baby wild and not allow him to become friendly with people. After a few weeks, I removed the smaller (pink) pins and the blue bar under anesthesia. The area felt solid and looked to be healing beautifully! Sometimes we’ll leave the long intramedullary (purple) pin in for a week or two longer to give the bone time to adjust to not having these supports any longer. But for heron, I removed it all at the same time since it felt so strong and he was growing so quickly.

Once the pins were removed, you couldn’t even tell which wing was the injured one! Now that his wing was done healing and he didn’t need special medications or handling any longer, we transferred this patient to the Wildlife Center of the North Coast (WCNC) in Astoria. We partner with local wildlife rehabilitation centers to move patients, especially babies if it means they can grow up around their own species in an effort to not allow them to become friendly or reliant on people. Thankfully WCNC had admitted a young blue heron around the time our patient’s pins were removed. He got to grow up with them in their large flight enclosures – learning to fish, hunt, and fly on his way to release with other great blue herons. Although I wish I could have watched him grow up in person, I know it’s what’s best for him.

And as a cherry on top of this wonderful success story, I just spoke with the Wildlife Center of the North Coast’s Executive Director, and he informs me our great blue heron patient #21-1045 has since been released! Fly free and strong, little guy! We’re all rooting for you!