,transcrib]'s ,note3 ,und]scores 80 be=e & aft] a ^w or phrase indicate italics 9 ! orig9al text4 ,small capitals h be5 conv]t$ to ,,solid capitals4 ,old or antiquat$ spell+s h be5 pres]v$4 ,on ,pg #agc1 ! ref]5ce to 8plate ,no4 #ha0 0 correct$ to 8plate ,no4 #hj04 ,on ,pg #aha1 ! ref]5ces to 8plates #he & #hf0 0 correct$ to 8plates #hc & #hd04 ,,w> ,,dep>tm5t 33 ,,(fice ,,( ,,! ,,surgeon ,,g5]al ,,bullet9 ,no4 #i ,,octob]1 #aiae ,,gun%ot ,,ro5tg5ograms ,a ,,collection ,,( ,,ro5tg5ograms ,,tak5 ,,9 ,,con/ant9ople ,,dur+ ,,! ,,turko-,,balkan ,,w>1 #aiab-aiac1 ,,illu/rat+ ,,"s ,,gun%ot ,,w\nds ,,9 ,,! ,,turki% ,,army ,,by ,,clyde ,s4 ,,=d ,major1 ,m$ical ,corps ,,publi%$ ,,by ,,au?ority ,,( ,,! ,,act ,,( ,,congress ,,approv$ ,,m>* #c1 #aiae1 ,,& ,,) ,,! ,,approval ,,( ,,! ,,secret>y ,,( ,,w>1 ,,= ,,! ,,in=mation ,,( ,,m$ical ,,(fic]s ,illu/ration ,,wa%+ton ,,gov]nm5t ,,pr9t+ ,,(fice #aiaf ,,table ,,( ,,illu/rations4 ,,rifle ,,w\nds4 ,,head4 ,page4 ,,plate #a4 ,gun%ot fracture1 skull1 lodgm5t ( missile #ab #b4 ,gun%ot fracture1 head1 lodgm5t ( missile #ad #c4 ,gun%ot fracture1 l[] jaw1 ramus #af #d4 ,gun%ot fracture1 l[] jaw1 ramus #ah #e4 ,gun%ot fracture1 l[] jaw1 body #bj ,,sp9al ,,region4 #f4 ,gun%ot w\nd1 sp9al region1 lodgm5t ( missile #bb #g4 ,gun%ot w\nd1 sp9al region1 lodgm5t ( missile #bd ,,upp] ,,extremity4 #h4 ,gun%ot fracture1 hum]us #bf #i4 ,gun%ot fracture1 hum]us1 lodgm5t ( missile #bh #aj4 ,gun%ot fracture1 hum]us1 lodgm5t ( missile #cj #aa4 ,gun%ot fracture1 hum]us #cb #ab4 ,gun%ot fracture1 hum]us #cd #ac4 ,gun%ot fracture1 hum]us #cf #ad4 ,gun%ot fracture1 hum]us1 lodgm5t ( missile #ch #ae4 ,gun%ot fracture1 hum]us1 ext]nal condyle #dj #af4 ,gun%ot fracture 7a7 hum]us1 7b7 ulna #db #ag4 ,gun%ot fracture1 elb[ #dd #ah4 ,gun%ot fracture1 elb[ #df #ai4 ,gun%ot fracture1 elb[ #dh #bj4 ,gun%ot fracture1 elb[ #ej #ba4 ,gun%ot fracture1 radius & ulna #eb #bb4 ,gun%ot fracture1 radius & ulna #ed #bc4 ,gun%ot fracture1 radius & ulna #ef #bd4 ,gun%ot fracture1 radius & ulna #eh #be4 ,gun%ot fracture1 radius #fj #bf4 ,gun%ot fracture1 radius #fb #bg4 ,gun%ot fracture1 radius #fd #bh4 ,gun%ot fracture1 radius #ff #bi4 ,gun%ot fracture1 radius1 l[] end #fh #cj4 ,gun%ot fracture1 radius1 l[] end #gj #ca4 ,gun%ot fracture1 radius1 l[] end #gb #cb4 ,gun%ot fracture1 ulna #gd #cc4 ,gun%ot fracture1 ulna #gf #cd4 ,gun%ot fracture1 ulna #gh #ce4 ,gun%ot fracture1 ulna #hj #cf4 ,gun%ot fracture1 ulna #hb #cg4 ,gun%ot fracture1 ulna #hd #ch4 ,gun%ot fracture1 ulna #hf #ci4 ,gun%ot fracture1 ulna #hh #dj4 ,gun%ot fracture1 ulna #ij #da4 ,gun%ot fracture1 wri/ #ib #db4 ,gun%ot fracture1 wri/ #id #dc4 ,gun%ot fracture1 metac>pus #if #dd4 ,gun%ot fracture1 phalanx #ih ,,*e/4 #de4 ,gun%ot w\nd1 *e/ #ajj ,,pelvis4 #df4 ,gun%ot w\nd1 pelvis #ajb ,,l[] ,,extremity4 #dg4 ,gun%ot w\nd1 gluteal region #ajd #dh4 ,gun%ot w\nd1 ?igh #ajf #di4 ,gun%ot w\nd1 ?igh #ajh #ej4 ,gun%ot w\nd1 ?igh #aaj #ea4 ,gun%ot w\nd1 ?igh #aab #eb4 ,gun%ot fracture1 femur #aad #ec4 ,gun%ot fracture1 femur #aaf #ed4 ,gun%ot fracture1 femur #aah #ee4 ,gun%ot fracture1 femur #abj #ef4 ,gun%ot fracture1 femur #abb #eg4 ,gun%ot fracture1 femur #abd #eh4 ,gun%ot fracture1 femur #abf #ei4 ,gun%ot w\nd1 knee #abh #fj4 ,gun%ot fracture1 tibia & fibula #acj #fa4 ,gun%ot fracture1 tibia & fibula #acb #fb4 ,gun%ot fracture1 tibia #acd #fc4 ,gun%ot fracture1 tibia #acf #fd4 ,gun%ot fracture1 tibia #ach #fe4 ,gun%ot fracture1 tibia #adj #ff4 ,gun%ot fracture1 tibia #adb #fg4 ,gun%ot fracture1 tibia #add #fh4 ,gun%ot fracture1 tibia #adf #fi4 ,gun%ot fracture1 tibia #adh #gj4 ,gun%ot fracture1 tibia #aej #ga4 ,gun%ot fracture1 fibula #aeb #gb4 ,gun%ot fracture1 ankle #aed #gc4 ,gun%ot w\nd1 heel #aef #gd4 ,gun%ot w\nd1 heel #aeh ,,%rapnel ,,w\nds4 ,,head4 #ge4 ,gun%ot fracture1 v]tex #afj #gf4 ,gun%ot fracture1 v]tex #afb #gg4 ,gun%ot fracture1 zygoma #afd #gh4 ,gun%ot fracture1 ma/oid process #aff #gi4 ,gun%ot fracture1 maxilla #afh #hj4 ,gun%ot fracture1 supra-orbital #agj #ha4 ,gun%ot fracture1 supra-orbital #agb #hb4 ,gun%ot w\nd1 %\ld] #agd #hc4 ,gun%ot w\nd1 %\ld] #agf #hd4 ,gun%ot w\nd1 %\ld] #agh #he4 ,gun%ot w\nd1 %\ld] #ahj #hf4 ,gun%ot fracture1 clavicle #ahb #hg4 ,gun%ot fracture1 hum]us #ahd #hh4 ,gun%ot fracture1 hum]us #ahf #hi4 ,gun%ot fracture1 hum]us #ahh #ij4 ,gun%ot fracture1 hum]us #aij #ia4 ,gun%ot fracture1 hum]us #aib #ib4 ,gun%ot fracture1 hum]us #aid #ic4 ,gun%ot fracture1 hum]us #aif #id4 ,gun%ot fracture1 hum]us #aih #ie4 ,gun%ot fracture1 hum]us #bjj #if4 ,gun%ot fracture1 hum]us & elb[ #bjb #ig4 ,gun%ot fracture1 elb[ #bjd #ih4 ,gun%ot fracture1 elb[ #bjf #ii4 ,gun%ot fracture1 elb[ #bjh #ajj4 ,gun%ot fracture1 elb[ #baj #aja4 ,gun%ot fracture1 radius & ulna #bab #ajb4 ,gun%ot fracture1 radius #bad #ajc4 ,gun%ot fracture1 radius #baf #ajd4 ,gun%ot fracture1 ulna #bah #aje4 ,gun%ot fracture1 metac>pus #bbj #ajf4 ,gun%ot fracture1 metac>pus #bbb #ajg4 ,gun%ot fracture1 metac>pus #bbd #ajh4 ,gun%ot w\nd1 h& #bbf #aji4 ,gun%ot w\nd1 multiple1 h& & =e>m #bbh ,,*e/4 #aaj4 ,gun%ot w\nd1 *e/ #bcj #aaa4 ,gun%ot w\nd1 *e/ #bcb #aab4 ,gun%ot w\nd1 *e/ #bcd #aac4 ,gun%ot w\nd1 *e/ #bcf #aad4 ,gun%ot w\nd1 *e/ #bch ,,pelvis4 #aae4 ,gun%ot fracture1 ilium #bdj ,,l[] ,,extremity4 #aaf4 ,gun%ot w\nd1 ?igh #bdb #aag4 ,gun%ot w\nd1 ?igh #bdd #aah4 ,gun%ot w\nd1 ?igh #bdf #aai4 ,gun%ot w\nd1 femur #bdh #abj4 ,gun%ot w\nd1 femur #bej #aba4 ,gun%ot w\nd1 femur #beb #abb4 ,gun%ot w\nd1 femur #bed #abc4 ,gun%ot w\nd1 femur #bef #abd4 ,gun%ot w\nd1 femur #beh #abe4 ,gun%ot w\nd1 femur #bfj #abf4 ,gun%ot w\nd1 femur #bfb #abg4 ,gun%ot w\nd1 femur #bfd #abh4 ,gun%ot w\nd1 knee #bff #abi4 ,gun%ot w\nd1 knee #bfh #acj4 ,gun%ot w\nd1 knee #bgj #aca4 ,gun%ot w\nd1 knee #bgb #acb4 ,gun%ot w\nd1 knee #bgd #acc4 ,gun%ot w\nd1 knee #bgf #acd4 ,gun%ot w\nd1 knee #bgh #ace4 ,gun%ot w\nd1 leg #bhj #acf4 ,gun%ot w\nd1 leg #bhb #acg4 ,gun%ot fracture1 tibia & fibula #bhd #ach4 ,gun%ot fracture1 tibia & fibula #bhf #aci4 ,gun%ot fracture1 tibia & fibula #bhh #adj4 ,gun%ot fracture1 tibia & fibula #bij #ada4 ,gun%ot fracture1 tibia #bib #adb4 ,gun%ot fracture1 fibula #bid #adc4 ,gun%ot fracture1 fibula #bif #add4 ,gun%ot fracture1 fibula #bih #ade4 ,gun%ot fracture1 fibula #cjj #adf4 ,gun%ot fracture1 fibula #cjb #adg4 ,gun%ot fracture1 fibula #cjd #adh4 ,gun%ot fracture1 8,pott's0 #cjf #adi4 ,gun%ot w\nd1 multiple1 leg #cjh #aej4 ,gun%ot fracture1 a/ragalus #caj #aea4 ,gun%ot fracture1 calcaneus #cab #aeb4 ,gun%ot w\nd1 heel #cad #aec4 ,gun%ot w\nd1 heel #caf #aed4 ,gun%ot w\nd1 foot #cah #aee4 ,gun%ot w\nd1 foot #cbj #aef4 ,gun%ot w\nd1 foot1 multiple #cbb ,,op]ative ,,int]f]5ce1 ,,gun%ot ,,w\nds4 #aeg4 ,gun%ot fracture1 hum]us #cbd #aeh4 ,gun%ot fracture1 ulna #cbf #aei4 ,gun%ot fracture1 radius & ulna #cbh #afj4 ,gun%ot fracture1 tibia & fibula #ccj #afa4 ,amputation1 knee #ccb #afb4 ,excision1 head ( hum]us #ccd ,,introduction ,^! ro5tg5ograms are n pres5t$ z exhibit+ a /ate ( p]fection 9 ! art or me?od by :i* !y 7 produc$1 al?\gh !y %[ ! results ( "s ( ! be/ & mo/ mod]n app>atus ( ,europe employ$ 9 ! h&s ( v skillful op]ators4 ,"s plates are includ$ :i* are indi/9ct & g5]ally s unsatisfactory f a te*nical viewpo9t z to be ( little int]e/1 if all ( !m 7 n int5d$ to %[ ! g5]al "* ( ! diagno/ic assi/ance t ! ro5tg5ologi/ r5d]$ ! milit>y surgeon 9 ! base hospitals ( ,con/ant9ople dur+ ! ,turko-,balkan ,w>4 ,! collection ( ^! plates result$ f a sy/ematic visit+ ( ! hospitals ( ,con/ant9ople 9 ! w9t] ( #aiab-ac1 dur+ ! c\rse ( ! fir/ ,balkan ,w>1 & includ+ all ( ! milit>y hospitals ( ! milit>y zone1 ) ! incid5tal purpose ( select+ f ! ro5tg5ographic plates1 :i* _h be5 prep>$ :]ev] app>atus 0 in/all$1 su* examples ( ! ro5tg5ography ( gun%ot w\nds z might %[ *>act]i/ic lesions )\t relation to detail$ cl9ical record4 ,m ?an #a1ejj plates 7 exam9$1 & f !m m ?an #bjj 7 select$ z exhibit+ "s lesion t seem$ to be *>act]i/ic ( "s =m ( gun%ot w\nd1 ev5 ?\gh ! case hi/ory c\ld n be obta9$4 ,f ^! select$ plates photographic pr9ts 7 made4 ,z "s ( ^! photographs display$ some:at simil> conditions1 only #afb ( !m are h]e) produc$4 ,z ! photographic & reproduction processes h transf]r$ ! rights & lefts ( ! orig9al negatives sev]al times1 ! plates z !y appe> "h are int]pret$1 = "r & left1 z ?\gh !y 7 ! orig9al photographic plates1 :i* are physically positive al?\gh !y are *emically negative2 i4 e41 ! "r & left sides ( ! page %\ld be read z ! "r & left sides anatomically4 ,if ?is di/9ction be n obs]v$1 "s confusion may arise f ! habit ( ro5tg5ologi/s 9 reg>d+ a ro5tg5ograph z a positive pr9t ( a negative plate4 ,i regret t ,i c n "h ackn[l$ge by "n my appreciation & gratitude to ! ro5tg5ologi/s ( all hospitals f :i* ,i secur$ p]mission to reproduce _! plates4 ,to ,pr(4 ,wiet+ ,pa%a1 ! comm&ant ( ,gulhan ,hospital2 to ,dr4 ,i%mael ,bey1 ! ro5tg5ologi/ ( ! ,ham$ian ,hospital2 to ,dr4 ,engl&]1 ! ro5tg5ologi/ ( ! ,au/rian ,hospital--to all ( :om ,i am p>ticul>ly indebt$--,i wi% to ackn[l$ge my ?anks4 ,projectiles4--,! projectiles :i* figure 9 ! illu/rations 7 ^? employ$ by ! nations at w>4 ,!y are d]iv$ 7#a7 f ! ,turki% po9t$ bullet weigh+ approximately #ae4j grams--x is fir$ f ! ,g]man ,maus] & has all ! balli/ic values ( ! projectile f ?is weapon2 7#b7 ! ,bulg>ian bullet1 blunt nos$ or ogival head$ & ! same z ! /eel-jacket$ bullet ( ! ,au/rian ,mannli*]2 7#c7 %rapnel balls & fragm5ts ( ! %rapnel1 & 7#d7 fragm5ts ( /eel %ells f field artill]y4 ,dur+ ! evolution ( r$uc$ calib] rifles exp]im5ts 7 made on cadav]s at diff]5t ranges4 ,9 ! publi%$ writ+s ( ^! work]s a great deal 0 said on ! subject ( highly de/ructive effects :i* are pretty g5]ally describ$ z explosive effects4 ,! exp]im5t]s 7 c>eful to expla9 t ^! exagg]at$ & highly de/ructive effects 7 only se5 :5 fir+ into cadav]s at close ranges & :5 ! bullet travel+ at a maximum velocity happ5$ to collide ) resi/ant /ructures l ! compact sub/ance ( bone 9 ! diaphysis ( ! long bones1 su* z ! femur1 tibia1 hum]us1 etc41 & ! head1 z well z organs load$ ) fluid or semifluid masses l ! /oma*1 ur9>y bladd]1 & inte/9es4 ,9 o!r tissues (f]+ b little resi/ance l lung tissues1 s(t p>ts g5]ally1 & epiphyseal ends ( bone1 ! w\nds inflict$ 7 consid]$ humane 9 "*4 ,att5tion %\ld be call$ to ! infrequ5cy ( w\nds %[+ explosive effects by ! rifles ( r$uc$ calib] employ$ 9 ! ,turko-,balkan & ,spani%-,am]ican w>s4 ,! same ?+ may be said ( ! ,turko-,italian1 ,anglo-,bo]1 & ,russo-,japanese w>s1 all ( :i* 7 f\ght ) ! new armam5t4 ,! reason = ! infrequ5cy ( ! explosive effects 9 ^! w>s is due to ! fact t ! battles 7 f\ght 9 ! op5 at ! ord9>y battle ranges beyond ! zone ( explosive effects4 ,?is fact is all ! m emphasiz$ 9 ! pres5t _w w>1 9 :i* ! rifle fire is employ$ pr9cipally 9 tr5* w>f>e at ne>-by ranges1 & :]e all ! w\nds :i* involve ! resi/ant /ructures ( ! body %[ ! *>act]i/ic features usually describ$ z ^? ( explosive effects4 ,9 describ+ ! plates ! t]ms us$ 9 connection ) range are z foll[s3 7#a7 ,close range1 f #j to #ajj y>ds4 7#b7 ,%ort range1 f #ajj to #ejj y>ds4 7#c7 ,mid range1 f #ejj to #a1jjj y>ds4 7#d7 ,long range1 f #a1jjj to #b1jjj y>ds4 ,! w\nd effects ( ! mod]n milit>y rifle bullet at v>i\s ranges are usually classifi$ z foll[s3 7#a7 ,explosive range1 f #j to #ejj y>ds4 7#b7 ,p]=at+ range1 f #ejj to #a1ejj y>ds4 7#c7 ,p5etrat+ range1 f #a1ejj to #b1ejj y>ds4 ,! difficulty 9 adh]+ /rictly to ! la/ table z f> z ! *>act]i/ic features ( w\nds are conc]n$ is ?is3 ,9 battle ! *ances ( rico*ett+ ( bullets is said to be 9 ! proportion ( "o to ?ree4 ,naturally1 ! mom5t a bullet rico*ets x loses m or less ( its rema9+ velocity4 ,! de/ructive lesion to be expect$ f a giv5 %ot at a giv5 range aga9/ a c]ta9 resi/ant /ructure c n be dep5d$ ^u to occur z x w :5 ! %ot is made ) sci5tific accuracy 9 ! %oot+ gall]y aga9/ cadav]s4 ,trajectory1 or ! curv$ l9e ( flight ( a projectile1 has no?+ to d ) its w\nd-produc+ quality1 except to increase ! w\nd-produc+ frequ5cy :5 x flatt5s & approa*es ! /raight l9e ( sight1 because x w !n pass ?r\gh a great] portion ( ! space betwe5 ! gun & ! t>get1 :i* may be occupi$ by m51 )\t go+ ov] _! heads4 ,! great] ! velocity1 ! flatt] ! trajectory becomes4 ,! ,am]ican1 ,g]man1 & ,turki% rifles1 ) ab\t ! same trajectory1 c be fir$ ?r\gh a tube #bd in*es 9 diamet] at a range ( #ejj y>ds1 & ! v]tical rise ( ! curve ( flight w\ld n hit ! top ( ! tube4 ,b :]e ! range is increas$ to #a1jjj y>ds x w\ld be necess>y to enl>ge ! tube to a tunnel1 #ae feet 9 diamet]1 9 ord] to fire ! bullet ?r\gh x )\t /rik+ ! top 9 its greatly increas$ curve 9 flight4 ,velocity is ! pr9cipal factor ( ! w\nd-produc+ p[] ( ! small-calib] bullet1 al?\gh ! latt] quality is def9itely relat$ to ! cross-sectional area & weight z well z to ! h>d metal jacket :i* pres]ves its =m4 ,! great] ! velocity ( any p>ticul> bullet ! m s]i\s is its w\nd4 ,en]gy1 z ! resultant ( ! compon5ts ( weight & velocity1 repres5ts ! real damag+ quality1 /rik+ =ce1 or 8pun*0 ( a projectile1 ) a v>iation 9 w\nd effect z ! en]gy is di/ribut$ ov] ! surface ( ! body1 ?r\gh ! cross-sectional area & ! =m ( ! po9t ( ! projectile1 & ! elem5ts ( con/ruction :i* a affect ! pres]vation ( its %ape4 ,z ! en]gy is express$ 9 ! =mula1 ,e 7,,wv#b7_/7b;g71 x is evid5t t ! increase or decrease ( ! velocity factor gives great] v>iation ?an ! increase ( weight4 ,range is important only z indicat+ ! am\nt ( rema9+ en]gy :i* may be kn[n to reside 9 ! projectile at any /age ( its flight4 ,)\t ref]5ce to ! balli/ic condition 7velocity1 weight1 =m1 & con/ruction1 etc47 ( a p>ticul> projectile1 range has no surgical significance4 ,to ! milit>y surgeon1 h[ev]1 x is a t]m ( ! greate/ int]e/ :5 ^! balli/ic conditions are kn[n1 z x gives him a v def9ite indication ( ! rema9+ en]gy or ! damag+ effect ( a projectile at ! diff]5t /ages 9 its flight4 ,! rema9+ en]gy ( ! ,am]ican 8,spr+field10 or ,g]man 8,s0 bullet1 = in/ance1 w pass x ?r\gh ! bodies ( two m5 at #b1jjj y>ds & an en]gy ( #h kilogram-met]s1 :i* rema9s at ab\t twice t di/ance1 w cause a disabl+ w\nd4 ,w\nd infections are m r>e 9 campaign 9 ! m sp>sely settl$ & r\gh c\ntries ) soldi]s ( ! m primitive class1 simple dome/ic habits1 & great] natural resi/ance4 ,w\nd treatm5t %\ld be prim>ily direct$ t[>d ! control ( infection ) only second>y reg>d = ! correction ( de=mities :i* %\ld foll[ z a second>y measure aft] resolution is e/abli%$4 ,all treatm5t %\ld be bas$ on pr9ciples appli$ 9 ! foll[+ ord]3 7#a7 ,life sav+4 7#b7 ,re/oration ( function4 7#c7 ,economy ( ! pati5t4 ,amputation %\ld be v r>e4 ,cons]vation to a degree t seems to be beyond ! exp]i5ce & conception ( ! civil surgeon %\ld always be practic$1 z reit]at$ by ,delorme1 :o says3 8,9 ord] to avoid ! excess ( op]ative measures :i* has be5 se5 9 rec5t w>s ,i am urg$ to enjo9 all pot5tial milit>y surgeons to practice almo/ uni=m cons]vation40 ,weight & muzzle velocity ( sev]al projectiles4 ---------------------------------------- ------------------ ,weight4 ,velocity4 ,projectile4 --------------------------------- ,grams4 ,gra9s4 ,met]s4 ,feet4 ---------------------------------------- ---------------- ,am]ican 7,spr+field7 #i4jg #aej #hjj #b1gjj ,fr5* #ab4h #aig #gja #b1cja ,g]man #aj4j #aed #hfj #b1hba ,au/rian #ae4h #bdd #fbf #a1ieb ---------------------------------------- ---------------- ,illu/ration3 ,plate #a4 ,,rifle--,,plate #a4 ,,head4 ,gun%ot ,fracture ( ! ,skull1 ) ,lodgm5t ( ! ,missile4 ,! bullet 9 ?is case 0 s badly de=m$ by rico*et t "p ( bo? core & jacket 7 lo/4 ,:ile ! appe>ance ( ! %ad[ seems to indicate a direct impact ( ! nose ( ! bullet1 ! l9e ( contact ) ! skull mu/ h be5 tang5tial1 ) "s lac]ation ( ! scalp2 o!rwise a cursory exam9ation ( ! scalp w\nd w\ld h reveal$ ! slightly protrud+ end ( ! bullet4 ,! d>k %ad[ above ! projectile is due to mat]ial us$ 9 dress+4 ,! great ?ick5+ ( ! scalp 9 ! region ( ! w\nd %[s a m>k$ cellulitis4 ,small p>ticles ( ! lead core ( ! bullet c be se5 ab\t ! w\nd4 ,9 su* cases !re is (t5 a m>k$ infection ( ! scalp )\t ext5sion ( infection to ! cranial cavity1 except f neglect4 ,?is is a case1 ?\gh app>5tly simple1 9 :i* ! radiograph 0 necess>y = correct diagnosis )\t exploration4 ,! treatm5t 9 su* cases is cons]vative1 ) removal ( ! projectile & c>e ( ! sup]ficial infection or subsequ5t complications4 ,illu/ration3 ,plate #b4 ,,rifle--,,plate #b4 ,,head4 ,gun%ot ,w\nd ( ! ,head1 ) ,lodgm5t ( ! ,missile4 ,w\nd ( entrance1 ne> out] can?us1 ) c\rse ?r\gh eyeball to e?moid body4 ,w\nd ( exit1 none4 ,! ,bulg>ian ,mannli*] bullet1 %[n half actual size on ! plate1 mu/ be incl9$ on its long axis1 ab\t #cj f ! p]p5dicul>1 to ! plane ( ! plate4 ,! slight p5etration ( ! missile & its normal "* %[ t1 hav+ /ruck no int]v5+ object1 x indict$ ! w\nd at extreme range4 ,! treatm5t %\ld meet ! indication = removal ( missiles 9 all sup]ficial or easily accessible locations & :5 !y cause reaction4 ,results to be expect$ are favorable except = loss ( ! eye4 ,illu/ration3 ,plate #c4 ,,rifle--,,plate #c4 ,,head4 ,gun%ot ,fracture ( ! ,ramus ( ! ,l[] ,jaw4 ,w\nd ( entrance1 9 ! *eek beh9d ! angle ( ! m\?4 ,w\nd ( exit1 bel[ ! tip ( ! ma/oid4 ,! c\rse ( ! bullet 0 almo/ tang5tial to ! ramus ( ! jaw1 ant]opo/]iorly4 ,! slight fragm5tation1 :i* is h>dly m ?an a splitt+ ( ! bone1 ) little or no displacem5t1 indicates t ! w\nd 0 made by a rifle bullet at mod]ate velocity & at mid or long range4 ,treatm5t is expectant4 ,results are favorable4 ,illu/ration3 ,plate #d4 ,,rifle--,,plate #d4 ,,head4 ,gun%ot ,fracture ( ! ,ramus ( ! ,l[] ,jaw4 ,w\nd ( entrance1 ov] ! ant]ior bord] ( ! "r ramus4 ,w\nd ( exit1 b5ea? ! lobe ( ! e>4 ,! w\nd 0 made by a rifle bullet ) ! velocity ( long range1 because w\nds ( a %rapnel ball nev] %[ su* slight injury )\t lodgm5t or )\t m>ks ( lead4 ,! damage ( ! bone 0 v slight1 z only a sup]ficial fragm5t 0 *ipp$ (f4 ,!re 7 no signs ( prim>y infection4 ,reaction & p]io/itis sugge/$ ! radiograph aft] infection _h r>efi$ ! fragm5t1 %[n b v fa9tly on ! left side ( ! plate4 ,! po/]o-ant]ior skull radiograph 0 made ) ! face sup]impos$ ^u ! photographic plate4 ,treatm5t1 incision & dra9age4 ,results1 good4 ,illu/ration3 ,plate #e4 ,,rifle--,,plate #e4 ,,head4 ,gun%ot ,fracture ( ! ,body ( ,l[] ,jaw1 ) ,great ,fragm5tation & ,displacem5t4 ,w\nd ( entrance1 to ! left side ( ! m$ian l9e ( ! l[] jaw bel[ ! alveol> process1 ) c\rse rang+ d[nw>d & backw>d4 ,w\nd ( exit1 ) ext5sive lac]ation1 b5ea? l[] bord] ( ! bone4 ,! w\nd 0 caus$ by a rifle bullet at high velocity at or less ?an mid range4 ,! fragm5ts are _m & r small1 s t mu* bone 0 lo/ ?r\gh ! w\nd ( exit4 ,?is effect 0 produc$ by ! splitt+ due to ! relative friability ( ! bone & to ! imp>t+ ( ! mom5tum ( ! missile to ! deta*$ fragm5ts1 :i*1 toge!r ) ! missile1 effect$ ! consid]able lac]ation ( ! w\nd ( exit4 ,treatm5t1 difficult2 guid$ by septic conditions & surgical means available4 ,results 9 su* cases are favorable to life b topically unsatisfactory4 ,illu/ration3 ,plate #f4 ,,rifle--,,plate #f4 ,,sp9al ,,region4 ,gun%ot ,w\nd ( ! ,sp9al ,region--,lodgm5t ( ! ,missile 9 ! ,lumb> ,muscles4 ,! bullet is lodg$ deep 9 ! muscles ( ! back & n 9 ! abdom51 z det]m9$ by inspection ( ! plate4 7a7 ,! %ad[ ( ! bullet is enl>g$ lat]ally1 because1 :ile on ! side ( ! body next to ! plate & to ! sp9e1 x is at "s little di/ance f ! plate1 :i* acc\nts = ! l>g] diamet] ( ! %ad[2 & x is %ort5$ longitud9ally1 because its long axis is incl9$ at an angle to ! plate4 7b7 ,! outl9e ( ! %ad[ is di/9ct1 an evid5ce t x is extra-abdom9al1 z o!rwise its outl9e w\ld be blurr$ by ! diaphragmatic movem5t ( respiration imp>t$ to ! abdom9al visc]a dur+ ! ,rntg5 exposure4 ,illu/ration3 ,plate #g4 ,,rifle--,,plate #g4 ,,sp9al ,,region4 ,gun%ot ,w\nd ( ! ,sp9al ,region1 ) ,lodgm5t ( ! ,missile4 ,! bullet 0 ei!r dum-dumm$ or unjacket$ because its s(t nose mu%room$1 /rik+ ! cre/ ( ! ilium1 p5etrat$ ! lumb> muscles1 & /ruck ! side body ( ! ?ird lumb> v]tebra )\t produc+ fracture4 ,! exposure1 z ! sp9\s processes %[1 0 made ) ! sp9e next to ! plate1 & ! slight %ad[1 some:at l>g] ?an ! projectile--to judge ! size f ! unde=m$ diamet]--%[s x to be ant]ior to ! v]tebra4 ,! %ad[ is deep en\gh to indicate ! location fairly ne> to ! plate1 &1 almo/ c]ta9ly1 n 9 ! abdom9al cavity1 :]e ! di/ance f ! plate w\ld h made ! %ad[ less d5se & ! movem5t ( respiration probably w\ld h giv5 x a blurr$ outl9e4 ,! %ad[ ( ! localiz+ cross gives a /&>d ( d5sity to be comp>$ ) ! %ad[ ( ! projectile 9 mak+ ! e/imation4 ,! treatm5t is cons]vative2 only pa91 p>alysis1 impair$ function1 or sepsis indicate int]f]5ce4 ,illu/ration3 ,plate #h4 ,,rifle--,,plate #h4 ,,upp] ,,extremity4 ,comp\nd ,fracture ( ! ,hum]us 9 ,advanc$ ,/ate ( ,repair ) ,callus ,=mation4 ,w\nd ( entrance1 j above middle ( ant]ior aspect ( arm4 ,w\nd ( exit1 ab\t ! same height1 po/]iorly4 ,! c\rse ( ! missile 0 ant]opo/]ior1 ) high velocity ( %ort range ?r\gh ! bone ) a splitt+ effect1 leav+ a few fragm5ts1 l>ge & small1 :i* 7 n mu* displac$ & caus$ b little de=mity4 ,w\nd 0 n infect$4 ,! absorption ( small] & ! ov]lapp+ ( l>g] fragm5ts caus$ "s %ort5+4 ,treatm5t1 expectant4 ,results1 favorable4 ,illu/ration3 ,plate #i4 ,,rifle--,,plate #i4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,"r ,hum]us1 ) ,lodgm5t ( ! ,missile4 ,w\nd ( entrance1 ant]o-ext]nal aspect ( upp] ?ird ( arm4 ,w\nd ( exit1 none4 ,! missile1 de=m$ by rico*et1 /ruck ! bone ) greatly r$uc$ velocity & )\t suffici5t en]gy to p]=ate ! bone by :i* x 0 deflect$ slightly f its c\rse & lodg$ 9 ! arm4 ,?is is some?+ ( ! same effect t might h be5 caus$ by a %rapnel ball1 "u ! same balli/ic conditions ) a normal %rapnel velocity giv+ ab\t ! same p5etrat+ =ce4 ,! w\nd1 )\t infection1 is 9 ! fir/ week or two ( repair1 be=e any callus has =m$4 ,treatm5t is expectant4 ,results favorable4 ,illu/ration3 ,plate #aj4 ,,rifle--,,plate #aj4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,left ,hum]us1 ) ,lodgm5t ( ! ,missile4 ,w\nd ( entrance1 ant]ior surface ( upp] ?ird ( ! arm4 ,w\nd ( exit1 none4 ,! %ad[ ( ! missile %[s by its di/9ct outl9e & normal diamet] at ! tip t ! missile lies on ! side ne> ! plate2 ! %ort5$ l5g? ( ! projectile indicates t ! long axis lay 9 an acute angle ) a p]p5dicul> to ! plate4 ,! irregul> outl9e ( ! base ( ! %ad[ & ! fact ( lodgm5t %[s t ! missile 0 de=m$ & t x 0 incid5tally ret>d$ 9 velocity by rico*et1 s t its p5etrat+ =ce 0 n suffici5t to c>ry x ?r\gh ! arm4 ,! fragm5ts ( bone are l>ge & ! w\nd is ( ! same "* z might h result$ f a %rapnel ball1 = ! normal balli/ic conditions ( ! latt] simulate ! conditions t produc$ ! w\nd4 ,! dra9age tubes se5 9 ! plate indicate infection4 ,! conv5tional treatm5t 9 su* cases is dra9age & o!r managem5t ( ! infection )\t =mal se>* = ! projectile4 ,results %\ld be favorable4 ,illu/ration3 ,plate #aa4 ,,rifle--,,plate #aa4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,hum]us4 ,w\nd ( entrance1 ant]ior int]nal aspect ( middle & upp] ?ird ( arm4 ,w\nd ( exit1 opposite4 ,! missile has /ruck ! side ( ! bone & pursu$ a c\rse ?r\gh ! %aft1 s t a transv]se fracture1 z well z ! sep>ation ( sev]al m$ium-siz$ fragm5ts1 result$ f ! splitt+ effect ( ! missile4 ,a l>g] missile1 i4 e41 a %rapnel ball1 ) ! same /rik+ en]gy c\ld h be5 /opp$ by ! bone1 b a wid] di/ribution ( ! same en]gy c>ri$ by a l>g] cross section w\ld h produc$ l>g] fragm5ts4 ,9 ?is case ! location ( ! %rapnel ball w\ld furni% unque/ion$ evid5ce2 or1 if a %rapnel ball _h produc$ ?is p>ticul> bone de/ruction1 its pa? among ! fragm5ts w\ld h be5 m>k$ by traces ( lead4 ,two metal fragm5ts indicate t ! lead core ( ! bullet 0 expos$4 ,! w\nd1 n infect$1 0 treat$ expectantly4 ,result 9 su* cases is favorable4 ,illu/ration3 ,plate #ab4 ,,rifle--,,plate #ab4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,hum]us4 ,! c\rse ( ! missile 0 ant]opo/]ior ?r\gh ! middle ( ! arm4 ,! balli/ic conditions & l9es ( =ce appli$ to ! bone 7 some:at1 if n entirely1 simil> to ^? produc+ ! fracture %[n 9 plate #aa4 ,! missile /ruck ! wall ( ! %aft )\t pass+ ?r\gh ! m$ull>y canal1 b a second>y fragm5tation ( ! two l>ge fragm5ts did n foll[ except = ! break+ ( ! tip ( ! di/al fragm5t4 ,! range 0 long4 ,!re 0 little de=mity & no infection4 ,pla/] dress+ 0 appli$ & ! slight outl9e ( callus =mation indicates ! process ( repair4 ,! lack ( contra/ 9 ! %ad[ ( ! bone is due to ! opacity ( ! pla/] dress+ ?r\gh :i* ! ,ro5tg5 exposure 0 made4 ,treatm5t 9 su* cases is expectant4 ,results %\ld be uni=mly good4 ,illu/ration3 ,plate #ac4 ,,rifle--,,plate #ac4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,"r ,hum]us1 ) ,lodgm5t ( ! ,missile4 ,w\nd ( entrance1 ab\t middle ( ! ant]ior9t]nal aspect ( ! arm4 ,w\nd ( exit1 none4 ,! c\rse ( ! missile 0 f )\t1 d[nw>d & inw>d to a po9t ( lodgm5t above ! int]nal condyle4 ,! di/9ct outl9e & normal size ( ! base ( ! bullet %[s x to be ne> ! plate1 ) ! int]nal condyle next to ! plate 9 ! exposure4 ,! bullet mu%room$ :5 x /ruck ! bone ) a 8s(t nose10 9 :i* ! lead 0 n protect$ by a t\gh metal jacket4 ,x may h be5 dum-dumm$2 x is remotely possible t ! nose ( ! jacket 0 split by rico*et1 or x is m probable t x 0 ( ! unjacket$ v>iety4 ,! effect is id5tical ) t ( a %rapnel ball1 /rik+ ) its normal l[ velocity1 :i* is ab\t ! same z t ( ! missile 9 ?is w\nd4 ,! inv>iable *>act]i/ic ( a %rapnel w\nd ( a bone1 namely1 ! small p>ticles ( metal m>k+ its c\rse 9 contact ) ! bone1 is se5 9 ?is plate4 ,! treatm5t 9 su* cases is expectant1 ) due reg>d to ! "* ( ! infection1 & )\t prim>y se>* = ! missile4 ,! results are g5]ally favorable4 ,illu/ration3 ,plate #ad4 ,,rifle--,,plate #ad4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,hum]us1 ) ,lodgm5t ( ! ,missile4 ,! missile 0 a fragm5t ( a rico*et$ rifle ball1 ) a "p ( ! lead core c>ri$ 9 a portion ( ! jacket4 ,! c\rse 0 f be=e1 backw>d1 /rik+ ! hum]us 9 l[] ?ird1 & leav+ p>ticles ( lead along its trade4 ,! w\nd 0 only slightly infect$4 ,sev]al deta*$ fragm5ts ( bone h be5 remov$4 ,! treatm5t 9 su* cases is cons]vative1 ) managem5t ( ! infection & )\t =mal se>* = ! projectile4 ,! results 9 su* cases are favorable ) "s %ort5+ ( ! bone4 ,illu/ration3 ,plate #ae4 ,,rifle--,,plate #ae4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,ext]nal ,condyle ( ! ,left ,hum]us1 ) ,lodgm5t ( ! ,missile4 ,w\nd or entrance1 int]nal & po/]ior aspect ( ! arm above ! int]nal condyle4 ,w\nd ( exit1 none4 ,! bullet 0 greatly de=m$ by rico*et1 ) ! loss ( ! great] "p or all ( its jacket4 ,! l9e ( contact ( ! unprotect$ lead ) ! bone is m>k$ by ! same small fragm5ts ( lead almo/ inv>iably se5 9 %rapnel w\nds4 ,! balli/ic conditions 9 ?is case are q simil> to ^? ( a %rapnel w\nd1 z ! projectile has /ruck ! bone ) l[ velocity4 ,! v slight displacem5t ( a s+le l>ge fragm5t f :i* ! missile is slightly )drawn indicates t ! /rik+ en]gy 0 relatively l[ & t ! ela/ic tissues1 /ret*+ ar\nd ! missile at its /rik+ po9t1 contract$ aft] its en]gy _h be5 exp5d$ & !n )drew ! missile f its f>!/ po9t ( advance4 ,! treatm5t 9 su* cases w>rants only ! int]f]5ce sugge/$ by infection & ! int]f]5ce ( ! missile ) function4 ,! results expect$ are mo/ favorable4 ,illu/ration3 ,plate #af4 ,,rifle--,,plate #af4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,hum]us4 ,! transv]se c\rse ( ! bullet1 /rik+ ! po/]ior wall ( ! %aft )\t ent]+ ! m$ull>y canal1 has fractur$ ! bone transv]sely1 ) a t5d5cy t[>d splitt+ (f a l>ge fragm5t f ! di/al fragm5t4 ,! bullet "u ^! balli/ic conditions ( high velocity & n di/ant range might h bor$ its way ?r\gh ! cancell\s tissue ( ! epiphysis ( ! same bone )\t any fractures4 ,gun%ot ,fracture ( ! ,ulna4 ,! transv]se c\rse ( ! bullet 9 /rik+ ! ulna at high velocity & n di/ant range has %[n a t5d5cy to bore a hole ?r\gh ! bone4 ,a small] bullet or a l>g] bone ( ! same /ructure might easily h provid$ conditions to p]mit ?is effect4 ,! w\nds ( exit & entrance 9 ea* ( ^! w\nds pres5t$ almo/ id5tically ! same appe>ance4 ,! treatm5t 9 su* cases is t ( a simple fracture1 z !re is almo/ always no infection 9 su* w\nds4 ,results are favorable4 ,illu/ration3 ,plate #ag4 ,,rifle--,,plate #ag4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,elb[4 ,! bullet 9 transv]se c\rse & high velocity ?r\gh bo? bones ( ! =e>m /ruck ! head ( ! radius1 ?us />t+ sev]al splitt+ l9es ( fracture & sep>at+ l>ge fragm5ts4 ,small] fragm5ts :i* receiv$ "s ( ! en]gy ( ! missile h be5 c>ri$ along ) x 9 turn1 /rik+ ! ulna & c>ry+ away small] fragm5ts f x & caus+ ! lac]ation :i* m>ks ! w\nd ( exit4 ,su* w\nds1 ) lac]ation ( s(t p>ts & fragm5tation ( ! bone1 are prone to infection1 aga9/ :i* treatm5t is direct$4 ,! indications to be met are mu* l ^? ( ! w\nd %[n 9 plates #ah & #ai4 ,excision or imm$iate me?ods ( bone repair are contra9dicat$ by infection4 ,results w dep5d ^u ! nature & ext5t ( infection4 ,illu/ration3 ,plate #ah4 ,,rifle--,,plate #ah4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,elb[1 )\t ,injury to ! ,great ,vessels & ,n]ves4 ,w\nd ( entrance1 po/]ior to ! ext]nal condyle4 ,w\nd ( exit1 l>ge lac]ation 9 front & above ! int]nal condyle4 ,! w\nd is an example ( ! misnam$ 8explosive0 action ( a rifle bullet4 ,! =ce & direction ( ! missile1 9 high velocity1 split ! bone into _m fragm5ts1 &1 transmitt+ its en]gy to "s ( ! fragm5ts1 c>ri$ !m ?r\gh ! sk9 & caus$ ! l>ge lac]ation at ! po9t ( exit by ! simultane\s escape ( ! bullet & fragm5ts4 ,! w\nd 0 s heavily infect$1 t a cellulitis advanc$ to ! %\ld] & to ! wri/ to su* ext5t t ! arm 0 m>k$ by em95t surgical op9ion = amputation4 ,free incision1 dra9age1 antisepsis & incid5tal removal ( deta*$ fragm5ts controll$ ! infection & br\ght ab\t sl[ resolution4 ,aft] six mon?s ( c>eful treatm5t ! w\nd 0 heal$ ) an ankylos$ elb[ ) normal function ( ! =e>m1 except = limit$ rotation4 ,treatm5t indicat$ 9 su* cases is always cons]vative4 ,infections contra9dicate any =mal surgical int]f]5ce4 ,! dang]s ( infection 9 su* cases are to be risk$ to avoid amputation4 ,results may be consid]$ favorable ev5 ) elb[ ankylosis4 ,illu/ration3 ,plate #ai4 ,,rifle--,,plate #ai4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,elb[1 )\t ,injury to ! ,great ,vessels & ,n]ves4 ,?is is a plate made ( ! same subject %[n 9 plate #ah1 :5 convalesc5ce 0 sev]al weeks f>!r advanc$1 z is indicat$ by ! removal ( fragm5ts & ext5sive callus =mation4 ,bo? radiographs 7 made aft] ! appreh5sion ( sy/emic infection _h pass$2 ! second plate aft] an additional numb] ( fragm5ts _h be5 remov$4 ,illu/ration3 ,plate #bj4 ,,rifle--,,plate #bj4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,elb[4 ,w\nd ( entrance1 po/]ior aspect ( =e>m int]nal to & bel[ ! olecranon4 ,w\nd ( exit1 ext]nal bord] ov] head ( radius4 ,! c\rse ( ! bullet 0 diagonally ant]opo/]ior f )9 outw>d1 /rik+ ! po/]ior bord] ( ! upp] end ( ! ulna & pass+ ?r\gh ! head ( ! radius1 c>ry+ ! fragm5ts ( ! latt] be=e x & lac]at+ ! w\nd ( exit4 ,! en]gy ( impact also fissur$ ! upp] end ( ! %aft ( ! ulna & fractur$ ! neck ( ! radius )\t deta*+ ! l>ge fragm5ts4 ,?is is ! effect ( a rifle bullet at %ort range1 or possibly a rico*et %ot at mid range4 ,! em]g5cy treatm5t is antiseptic dress+ ) spl9t immobilization4 ,! subsequ5t treatm5t is cons]vative1 :e!r ! w\nd is clean or infect$4 ,! c\rse ( treatm5t ( su* an infect$ w\nd might ext5d f f\r to six mon?s4 ,,note4--,z ! soldi] always escapes ! burd5 ( explanation :5 ! w\nd ( entrance is ant]ior r ?an po/]ior1 x %\ld be rememb]$ t ! =e>m may occupy positions 9 relation to ! body :i* exposes ! anatomically po/]ior aspect ( ! =e>m to missiles direct$ t[>d ! ant]ior surface ( ! body2 & z ! w\nds ( ! =e>m h]e9 pres5t$ are describ$ 9 ! anatomical position1 !re is no ju/ifiable impea*m5t ( ! soldi]'s valor 9 an inf]5ce t he 0 %ot f beh9d :5 ! w\nd ( entrance involves ! po/]ior aspect ( ! =e>m4 ,illu/ration3 ,plate #ba4 ,,rifle--,,plate #ba4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,radius & ,ulna4 ,! c\rse ( ! bullet at %ort range 0 transv]se ?r\gh bo? ( ! bones1 ) a splitt+ effect & )\t mu* small fragm5tation4 ,! w\nd ( exit 9 ?is case 0 slightly lac]at$1 b n v mu* l>g] ?an ! w\nd ( entrance4 ,! treatm5t %\ld be cons]vative4 ,em]g5cy treatm5t %\ld n include exploration1 & no?+ b ! conv5tional iod9e dress+ & spl9ts %\ld be appli$4 ,illu/ration3 ,plate #bb4 ,,rifle--,,plate #bb4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,radius & ,ulna4 ,! c\rse ( ! bullet at %ort range 0 transv]se ?r\gh ! upp] =e>m1 /rik+ ! radius 9 ! c5t] ( ! %aft & ! ulna ne>] ! bord]4 ,sev]al small fragm5ts foll[$ ! c\rse ( ! bullet1 b did n em]ge ) x at ! w\nd ( exit to cause a lac]ation4 ,! capitellum 0 next to ! photographic plate & ! angul> l9e ( ! radius c be se5 cross+ ! /raight] l9e ( ! ulna4 ,fur!r in=mation is obta9$ f ! exam9ation ( ano!r view1 plate #bc1 made ( ! same subject4 ,illu/ration3 ,plate #bc4 ,,rifle--,,plate #bc4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,radius & ,ulna4 ,?is plate 0 made f ! w\nd %[n 9 plate #bb1 ) ! arm 9 great] inw>d rotation4 ,?is position %[s ! wide sep>ation ( ! l>ge fragm5ts ( ! radius4 ,em]g5cy treatm5t 9 su* cases is antiseptic dress+ only1 )\t exploration1 & ) fixation by spl9ts = transportation4 ,! degree ( infection det]m9es ! subsequ5t c\rse ( cons]vative treatm5t1 ) op]ative me?ods = correction ( de=mity res]v$ = fur!r /age ( convalesc5ce & = be/ surgical facilities4 ,illu/ration3 ,plate #bd4 ,,rifle--,,plate #bd4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,radius & ,ulna 9 ! ,upp] ,?ird ( ! ,=e>m4 ,! c\rse ( ! projectile 0 f )91 outw>d & diagonally =w>d1 ) a direct impact on ! ulna1 & a tang5tial impact on ! radius1 ) sev]al l9es ( splitt+ fracture 9 ! latt] )\t deta*+ fragm5ts4 ,p>ticles ( metal1 spatt]$ ar\nd ! po9t ( fir/ impact1 7 deposit$ by ! lead core ( a bullet1 expos$ by a torn jacket1 :i* /ruck ! second bone ) its jacket$ surface4 ,! treatm5t is always cons]vative--meet+ indications 9 case ( infection4 ,results are good = sav+ ! limb1 b n = avoid+ de=mity4 ,illu/ration3 ,plate #be4 ,,rifle--,,plate #be4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,radius4 ,w\nd ( entrance1 po/]ior surface ( =e>m ov] radius above ! middle4 ,w\nd ( exit1 bel[ & 9 front ( w\nd ( entrance4 ,! c\rse ( ! ball 9 mid range 0 f beh9d1 =w>d1 & slightly d[nw>d4 ,:ile ! images ( bo? bones ( ! =e>m are sup]impos$1 because !y bo? lay 9 ! plane ( ! projection ( ! %ad[1 x is probable t ! radius lay ne>] ! photographic plate1 because ! head ( ! radius is %[n 9 cle>] outl9e4 ,! fragm5ts ( ! fracture c be se5 z relat$ to ! outl9es ( ! radius4 ,!re is no displacem5t & only slight fragm5tation1 s t ! bullet mu/ h almo/ succe$$ 9 mak+ a punctur$ w\nd 9 ! radius4 ,! treatm5t 9 su* cases is regul>ly t = simple fracture1 z su* w\nds are almo/ always aseptic4 ,! results are uni=mly good4 ,illu/ration3 ,plate #bf4 ,,rifle--,,plate #bf4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,radius4 ,w\nd ( entrance1 midway betwe5 radius & ulna & midway betwe5 elb[ & wri/1 ant]ior aspect ( ! =e>m4 ,w\nd ( exit1 ov] radius at po9t opposite4 ,! c\rse ( ! bullet1 9 ! m$ium velocity ( mid range1 9 pi]c+ ! m$ull>y canal has almo/ succe$$ 9 drill+ ! bone )\t splitt+ (f sev]al longitud9al fragm5ts4 ,small fragm5ts foll[$ ! c\rse ( ! missile1 )\t be+ en]giz$ suffici5tly to lac]ate ! po9t ( exit by escap+ ) ! projectile4 ,! w\nd ( exit 9 su* cases h>dly diff]s en\gh f ! w\nd ( entrance to be di/+ui%able4 ,?is condition s (t5 obta9s t ! great majority ( p]=at+ rifle w\nds ( ! =e>m d n %[ ! bl[-out or 8explosive0 effect :i* seems to be g5]ally misund]/ood z a classic accompanim5t4 ,! bullet 0 travel+ at high velocity ( p]haps less ?an mid range4 ,! treatm5t is usually t ( a simple fracture1 & w>rants no int]f]5ce except 9 case ( occasional infection4 ,results are almo/ always good4 ,illu/ration3 ,plate #bg4 ,,rifle--,,plate #bg4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,radius4 ,! c\rse ( ! bullet1 at long range1 has be5 diagonally ant]opo/]ior ?r\gh ! %aft1 caus+ only a diagonal fracture4 ,! plate 0 made aft] a two-weeks' convalesc5ce1 z is %[n by ! beg9n+ ( callus =mation4 ,! treatm5t is t ( a simple fracture4 ,results are good4 ,illu/ration3 ,plate #bh4 ,,rifle--,,plate #bh4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,radius4 ,! c\rse ( ?is bullet 0 ant]opo/]ior & diagonally f above d[nw>d ?r\gh ! %aft1 pun*+ out "o side ( ! %aft & effect+ a diagonal fracture ?r\gh ! bone ) only slight displacem5t4 ,! w\nd 0 infect$4 ,! radiograph 0 tak5 dur+ ! c\rse ( treatm5t1 aft] ! sev]al small fragm5ts f\nd by ! pun*$-out portion ( ! bone 7 remov$4 ,a small dra9age tube is 9 ! w\nd1 b ! size ( ! =e>m %[s t ! reaction is v mod]ate4 ,! treatm5t is t ( a simple fracture1 except = ! indications to be met 9 ! control ( infection4 ,results are good4 ,illu/ration3 ,plate #bi4 ,,rifle--,,plate #bi4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,l[] ,end ( ! ,radius4 ,! c\rse ( ! bullet 9 long range 0 diagonally ant]opo/]ior ?r\gh ! uln> side ( ! l[] end ( ! bone1 ) ! w\nd ( entrance on ! ant]ior & ! w\nd ( exit on ! po/]ior aspect ( ! wri/4 ,! w\nd ( exit 0 slightly lac]at$ by sev]al small fragm5ts driv5 (f f ! uln> side ( ! radius4 ,^! fragm5ts 7 remov$ ?r\gh an incision be=e ! radiograph 0 made4 ,! em]g5cy treatm5t ( su* cases is only antiseptic dress+ & spl9t immobilization4 ,:5 w\nd is aseptic or aft] x has clos$1 a second>y op]ation = coaptation1 ) prop] facilities available1 might be indicat$4 ,! results z to full re/oration ( jo9t function are n favorable4 ,illu/ration3 ,plate #cj4 ,,rifle--,,plate #cj4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,l[] ,end ( ! ,radius4 ,! c\rse ( ! missile 0 diagonally transv]se1 /rik+ ! radius 9 its l[] ?ird4 ,! projectile 9 ?is case is unkn[n1 z x might h be5 ei!r a %rapnel ball or a de=m$ rifle bullet ) a torn jacket1 expos+ ! lead core & m>k+ its c\rse ) small p>ticles ( lead4 ,! fissures 9 ! l[] fragm5t & ! f9] fragm5tation at ! seat ( impact1 indicate a great /rik+ en]gy1 t m (t5 resides 9 ! high velocity ( a rifle bullet ?an ! l[ velocity ( a %rapnel ball4 ,! w\nd is !re=e classifi$ ) rifle w\nds4 ,! treatm5t is cons]vative4 ,! c\rse 9 su* cases1 )\t infection1 is v favorable1 & n unfavorable ev5 ) infection4 ,results %\ld be good4 ,illu/ration3 ,plate #ca4 ,,rifle--,,plate #ca4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,l[] ,end ( ! ,radius4 ,w\nd ( entrance1 ant]ior aspect ( wri/1 ov] int]nal bord] ( radius4 ,w\nd ( exit1 po/]ior aspect ( wri/ betwe5 radius & ulna1 ) lac]ation4 ,! range 0 describ$ z 8close0--)9 a hundr$ y>ds--) ! bullet 9 high velocity4 ,! en]gy ( ! projectile1 imp>t$ to small fragm5ts ( cancell\s tissue1 drove !m ?r\gh ! w\nd ( exit1 & caus$ ! lac]ation ( ! sup]ficial tissues4 ,! w\nd 0 infect$ 7swell+ ( s(t p>ts cle>ly %[n73 resolution foll[$ ext5d$ treatm5t1 ) ankylosis ( ! wri/ & radial displacem5t ( ! c>pus4 ,em]g5cy treatm5t 9 all su* cases is antiseptic dress+ )\t exploration or manipulation ( fragm5ts1 & ) spl9t immobilization4 ,results are unfavorable z to function1 dep5d+ ^u ext5t ( de/ruction ( t5dons4 ,illu/ration3 ,plate #cb4 ,,rifle--,,plate #cb4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,ulna4 ,! c\rse ( ! bullet 0 transv]se ?r\gh ! arm at ! junction ( ! middle & upp] ?irds f beh9d ! radial bord] ext]nally to ! uln> bord] int]nally1 /rik+ ! wall ( ! m$ull>y canal ) a pun*+ effect t p>tly split (f %ort longitud9al fragm5ts & caus$ transv]se & longitud9al cracks1 )\t sep>ation or displacem5t ( fragm5ts4 ,! same balli/ic conditions appli$ to cancell\s tissue at ! end ( ! bone w\ld probably h bor$ ?r\gh x )\t fracture4 ,?is effect is g5]ally se5 9 w\nds ( small-calib] bullets travel+ at r$uc$ velocity ( long range4 ,! treatm5t is t ( a simple fracture4 ,results1 9 su* cases )\t infection1 c\ld n be bad4 ,illu/ration3 ,plate #cc4 ,,rifle--,,plate #cc4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,left ,ulna4 ,! c\rse ( ! missile 0 f )9 outw>d1 rang+ d[nw>d to ! wri/1 by deflection1 aft] /rik+ ! ulna 9 its upp] half4 ,! consid]able /rik+ en]gy reta9$ 9 a small portion ( ! mass--consi/+ ( only ! nose & a little m ( ! jacket ( ! bullet1 b suffici5t to fragm5t a l>ge section ( ! bone1 & !n to trav]se m ?an half ! l5g? ( ! =e>m--leaves no d\bt t ! %ot 0 fir$ at v close range1 & t ! bullet 0 brok5 on a ne>ly resi/+ surface1 leav+ 9 ! nose ( ! bullet a /rik+ =ce equal to t ( ! entire projectile at long range4 ,! po/]ior surface ( ! =e>m is next to ! plate1 z ! di/9ct outl9e ( ! /yloid process ( ! ulna & ! po/]ior bord] ( ! articul> surface ( ! radius %[s4 ,! radius & ulna are p>allel 9 ! mo/ natural position ( sup9ation4 ,! normal diamet] & %>p outl9e ( ! nose ( ! bullet %[ x to be next to ! plate & on ! po/]ior surface betwe5 radius & ulna4 ,fragm5ts ( ! expos$ lead core ( ! bullet h scrap$ (f on ! l9e ( fracture 9 a mann] peculi> to %rapnel w\nds1 b nev] se5 9 bullet w\nds 9 :i* ! jacket cov]s all ( ! lead core4 ,! treatm5t is regul>ly cons]vative & )\t int]f]5ce1 z 9 ?is p>ticul> w\nd1 :i* 0 aseptic4 ,second>y treatm5t may indicate correction ( bone de=mity4 ,illu/ration3 ,plate #cd4 ,,rifle--,,plate #cd4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,ulna4 ,! balli/ic conditions ( ! projectile caus+ ! w\nd %[n 9 ?is plate are sub/antially ^? ( ! w\nd %[n 9 plate #cb4 ,! w\nd ( entrance & exit w\ld be practically ! same 9 *ipp+ (f a few small fragm5ts & caus+ a clean transv]se fracture )\t any displacem5t4 ,! bullet at long range has /ruck ! wall ( ! m$ull>y canal1 appe>ance4 ,treatm5t t ( a simple fracture4 ,results mu/ be good4 ,illu/ration3 ,plate #ce4 ,,rifle--,,plate #ce4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,ulna4 ,! c\rse ( ! bullet at long range has be5 ant]opo/]ior ?r\gh ! middle ( ! =e>m1 pass+ ?r\gh ! side ( ! %aft1 *ipp+ (f a few small fragm5ts & caus+ a long oblique fracture4 ,! conditions 7 mu* ! same z ^? %[n 9 plates #bh & #bi1 except t ! /rik+ en]gy ( ! projectile 0 some:at great] ) ! velocity ( mid range4 ,! treatm5t1 )\t infection1 is t ( a simple fracture4 ,results w be uni=mly good4 ,illu/ration3 ,plate #cf4 ,,rifle--,,plate #cf4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,ulna4 ,! c\rse ( ! bullet 0 ant]opo/]ior ?r\gh ! ulna a little above ! middle ( ! =e>m1 & fairly ?r\gh ! long axis4 ,?is is a bone effect mu* simil> to ^? %[n 9 plates #bh1 #bi1 & #ca1 except t ?is condition is due to ! impact ( a missile1 ) a /ill high] velocity ( %ort] range1 imp>t+ its en]gy to small fragm5ts ( bone1 :i* add$ _! mom5tum to ! de/ructive =ce ( ! projectile4 ,no l>ge fragm5ts 7 c>ri$ along ) ! missile to cause any m de/ruction ( tissue 9 exit ?an 9 entrance1 s t ! sk9 w\nds1 "u ^! conditions1 are ab\t ! same 9 appe>ance4 ,! treatm5t is cons]vative & expectant ) immobilization4 ,results 9 su* cases are uni=mly good4 ,illu/ration3 ,plate #cg4 ,,rifle--,,plate #cg4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,ulna4 ,! c\rse ( ! bullet 0 9 an ant]opo/]ior direction at a high velocity ( %ort range1 :i*1 imp>t+ its en]gy to ! fragm5ts1 drove "s ( !m ?r\gh ! tissues z 8second>y missiles0 & caus$ a lac]ation ( ! w\nd to exi/4 ,! longitud9al fragm5tation & splitt+ indicates a consid]able en]gy ( ! projectile1 :i* may h be5 deflect$1 z its long axis 0 turn$ some:at f ! trajectory at ! "t ( impact4 ,! em]g5cy treatm5t is antiseptic dress+ & spl9t immobilization4 ,! subsequ5t treatm5t is cons]vative ) ! removal ( deta*$ fragm5ts & ) control ( infection z ! c\rse indicates4 ,illu/ration3 ,plate #ch4 ,,rifle--,,plate #ch4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,left ,ulna4 ,! c\rse ( ! bullet 0 transv]se ?r\gh ! middle ( ! =e>m1 /rik+ ! po/]ior bord] ( ! ulna4 ,small fragm5ts 7 brok5 f ! po/]ior wall ( ! m$ull>y canal1 )\t de/roy+ ! longitud9al cont9uity ( ! ant]ior wall4 ,! velocity ( ! bullet 0 probably t ( mid-range1 z ! /rik+ en]gy ( ! impact 0 fairly great4 ,! po/]ior surface ( ! =e>m lay next to ! plate4 ,! em]g5cy treatm5t is antiseptic dress+ & spl9t immobilization4 ,! subsequ5t treatm5t is t ( a simple fracture1 z infection is n usual4 ,illu/ration3 ,plate #ci4 ,,rifle--,,plate #ci4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,left ,ulna4 ,! c\rse ( ! bullet1 ) ! velocity ( long range1 0 ant]opo/]ior ?r\gh ! l[] ?ird ( ! =e>m1 /rik+ ! out] side ( ! bone4 ,! initial velocity ( ! projectile 0 mu* r$uc$1 z is %[n by ! t5d5cy to puncture ! bone )\t mu* fragm5tation4 ,!re 0 no displacem5t ( fragm5ts z a direct result ( ! impact1 al?\gh muscul> contraction has caus$ "s slight subsequ5t ov]rid+4 ,! w\nds ( entrance & exit 7 ab\t ! same1 if n q simil> 9 appe>ance4 ,! em]g5cy treatm5t is ! conv5tional antiseptic dress+ ) spl9t immobilization4 ,! subsequ5t treatm5t is usually t ( a simple fracture1 z infection 9 su* cases is r>e4 ,illu/ration3 ,plate #dj4 ,,rifle--,,plate #dj4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,ulna4 ,! c\rse ( ! bullet 0 obliquely ant]opo/]ior ?r\gh ! l[] ?ird ( ! =e>m1 /rik+ ! radial edge ( ! bone ) a velocity ( long range4 ,! w\nds %[n 9 plates #ce & #ci repres5t conditions simil> to ^? caus+ ?is w\nd1 except t ! ranges 7 progressively great]4 ,9 ?is case ! projectile exhibit$ a pun*+ effect at ! po9t ( impact1 & al?\gh ! l9es ( =ce are %[n 9 *>act]i/ically div]g5t fissures1 ! en]gy imp>t$ to ! fragm5ts--less ?an 9 ! prec$+ cases--has n be5 suffici5t to sep>ate or to displace ! fragm5ts4 ,! em]g5cy & subsequ5t treatm5t is conv5tionally cons]vative1 z 9 ! prec$+ cases4 ,illu/ration3 ,plate #da4 ,,rifle--,,plate #da4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,wri/4 ,w\nd ( entrance1 po/]ior aspect ( =e>m ov] ! l[] end ( ! radius1 ) ! bullet rang+ =w>d & slightly d[nw>d to ! w\nd ( exit & cov]+ ) great lac]ation ! ant]ior aspect ( ! wri/ jo9t4 ,! range 0 close1 & ! en]gy ( ! high velocity ( ! missile 0 imp>t$ to fragm5ts1 :i*1 becom+ 8second>y missiles10 em]g$ ) ! projectile to cause ext5sive lac]ation & de/ruction ( tissue4 ,! case 0 receiv$ = amputation 9 ! second week1 :5 a grave degree ( infection ext5d$ 9 a cellulitis to ! elb[4 ,! uln> n]ve & vessels 7 intact1 b ! flexor t5dons 7 almo/ entirely de/roy$4 ,! plate1 made aft] sev]al weeks1 :5 infection 0 "u control & aft] ! end ( ! radius & fragm5ts ( ! c>pus _h be5 in=mally remov$1 %[s a r>efaction ( ! c>pus & proximal ends ( ! metac>pus1 due to infection & disuse4 ,frequ5t incisions & ext5sion ( dra9age1 ) removal ( deta*$ fragm5ts1 0 cont9u$ = sev]al mon?s4 ,! w\nd 0 clos$ 9 ! six? mon?1 ) ankylosis & de=mity ( ! wri/1 z %[n 9 plate #db4 ,illu/ration3 ,plate #db4 ,,rifle--,,plate #db4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,wri/4 ,?is plate1 pres5t+ a lat]al view ( ! w\nd %[n 9 plate #da1 %[s consid]able de=mity ( ! jo9t1 aft] f\r mon?s' treatm5t1 :i* 0 ev5 m m>k$ two mon?s lat]1 :5 ! case 0 dis*>g$ ) an ankylosis ( ! wri/ jo9t1 contracture ( ! flexor t5dons ( ! f+]s1 & slight flexor function ( ! ?umb1 p]mitt+ apposition ) ! fir/ f+]4 ,! result1 :ile leav+ mu* to be desir$1 pres]v$ a function ( ! h& va/ly sup]ior to t ( a =e>m /ump4 ,! treatm5t 9 su* cases is always c\rage\sly cons]vative1 ) amputation only z ! extreme measure to save life1 ) risks ( judgm5t 9 favor ( cons]vatism4 ,corrective measures may be employ$ aft] managem5t if ! treatm5t ( ! infection is successful & :5 ! case passes out ( ! milit>y category4 ,x is n possible1 dur+ a long infection1 to ma9ta9 bett] position 9 su* cases4 ,illu/ration3 ,plate #dc4 ,,rifle--,,plate #dc4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,metac>pus4 ,w\nd ( entrance1 inn] aspect ( ! h& ov] proximal end ( ! fif? metac>pal4 ,w\nd ( exit1 on ! out] bord] ( ! h& ov] ! di/al end ( ! second metac>pal4 ,! velocity ( ! bullet 0 9 mid or long range1 z x displac$ no fragm5ts1 & z x made a po9t ( entrance & exit ab\t ! same 9 appe>ance4 ,! w\nd 0 infect$1 :i* is m frequ5tly ! case 9 ! h& ?an 9 ! =e>m4 ,! treatm5t is cons]vative ) free incision & dra9age 9 ! managem5t ( infection4 ,illu/ration3 ,plate #dd4 ,,rifle--,,plate #dd4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,?ird ,phalanx4 ,! c\rse ( ! bullet 0 ant]opo/]ior ?r\gh ! base ( ! proximal phalanx ( ! middle f+]1 ) a velocity ( long range4 ,x practically punctur$ ! bones & split (f a few fragm5ts )\t displacem5t4 ,! w\nd ( entrance w\ld be mu* ! same z ! w\nd ( exit1 ) ! latt]1 b a little l>g]4 ,treatm5t is cons]vative4 ,illu/ration3 ,plate #de4 ,,rifle--,,plate #de4 ,,*e/4 ,p5etrat+ ,gun%ot ,w\nd ( ! ,*e/1 ) ,lodgm5t ( ! ,projectile ,ne> ,po/]ior ,*e/ ,wall4 ,po9t ( entrance1 pectoral bord] & f\r? rib4 ,po9t ( exit1 none4 ,! di/9ct %ad[ ( ! angle ( ! ribs %[s t ! po/]ior *e/ wall 0 next to ! photographic plate1 & t ! l>g] & less di/9ct outl9e ( ! ant]ior portions ( ! upp] ribs 0 f>!r f ! plate4 ,! ne>ly normal size ( ! %ad[ ( ! projectile %[s x to be mu* ne>] ! po/]ior ?an ! ant]ior *e/ wall4 ,! blurr$ outl9e %[s x to h mov$ ) respiration4 ,su* conditions locate its position )9 ! ?oracic cavity4 ,! em]g5cy treatm5t is antiseptic dress+ & re/4 ,! subsequ5t treatm5t dep5ds ^u pleural involvem5t or ! extremely r>e infection ( ! lung4 ,^! cases are ne>ly all aseptic1 & if ! great vessels & n]ves ( ! *e/ escape injury results are g5]ally favorable4 ,illu/ration3 ,plate #df4 ,,rifle--,,plate #df4 ,,pelvis4 ,gun%ot ,w\nd ( ! ,pelvis1 ) ,lodgm5t ( ! ,missile 9 ! ,abdom54 ,! c\rse ( ! bullet 0 f beh9d =w>d1 /rik+ ! cre/ ( ! ilium1 on :i* x 0 deflect$1 & spatt]+ (f "s lead fragm5ts4 ,! slight p5etration indicates a velocity ( extremely long range & a /rik+ en]gy less5$ by rico*et4 ,! irregul> outl9e ( ! %ad[ ( ! projectile %[s its de=mity1 & ! blurr$ outl9e indicates intra-abdom9al movem5t ) respiration4 ,:ile ! missile1 z reveal$ by its %ad[1 is n a %rapnel ball1 ! di/ribution ( lead p>ticles is m sugge/ive ( a %rapnel ?an ( a rifle projectile1 & ! balli/ic conditions are m *>act]i/ic ( ! =m] ?an ( ! latt]4 ,!re 0 no abdom9al reaction2 ! invasion ( ! abdom5 0 reveal$ by ! radiograph4 ,! treatm5t 9 su* cases is non9t]f]5ce unless subsequ5t developm5ts furni% def9ite indications4 ,illu/ration3 ,plate #dg4 ,,rifle--,,plate #dg4 ,,l[] ,,extremity4 ,gun%ot ,w\nd ( ! ,gluteal ,region1 ) ,lodgm5t ( ! ,bullet ,ne> ! ,is*ium4 ,w\nd ( entrance1 ov] gluteal prom95ce on a transv]se l9e ?r\gh ! great tro*ant]4 ,w\nd ( exit1 none4 ,!re 0 no bone injury 9 ?is case4 ,! bullet1 to h lodg$ 9 ! s(t p>ts aft] relatively slight p5etration1 mu/ h /ruck ! body at extreme range :5 its en]gy 0 almo/ sp5t 9 flight1 = its normal outl9e indicates t x 0 n ret>d$ by rico*et4 ,! long axis is almo/ p]p5dicul> to ! plate4 ,z ! po/]ior pelvis 0 next to ! plate1 ! fairly d5se %ad[ %[s ! projectile 0 n f> f ! plate & beh9d ! is*ium4 ,! treatm5t is cons]vative2 infection 9 su* cases is extremely r>e2 & only pa9 or impair$ function aft] _m mon?s ( convalesc5ce ju/ifies op]ation = removal ( ! missile4 ,illu/ration3 ,plate #dh4 ,,rifle--,,plate #dh4 ,,l[] ,,extremity4 ,gun%ot ,w\nd ( ! ,?igh1 ) ,lodgm5t ( ! ,bullet4 ,w\nd ( entrance1 out] aspect ( ! ?igh at ! junction ( ! upp] & middle ?irds4 ,! slight p5etration )\t bone injury & ) slight de=mity ( ! nose ( ! bullet indicates t ! w\nd 0 caus$ by a rico*et %ot at extreme range1 aft] its en]gy 0 almo/ sp5t4 ,) ! po/]ior aspect ( ! ?igh next to ! plate1 ! d5se %ad[ & ! ne>ly normal size ( its outl9e indicate t ! bullet 0 9 ! same relative position & t x lay po/]ior to ! neck ( ! femur4 ,z su* w\nds are r>ely infect$1 ! treatm5t is cons]vative1 & a se>* = ! missile is only ju/ifi$ by s]i\s infection1 pa91 or impair$ function4 ,illu/ration3 ,plate #di4 ,,rifle--,,plate #di4 ,,l[] ,,extremity4 ,gun%ot ,w\nd ( ! ,"r ,?igh1 ) ,lodgm5t ( ! ,bullet ,beh9d ! ,femur4 ,!re is no injury ( ! bone 9 ?is case1 z ! bullet lodg$ 9 ! muscles po/]ior to ! l[] ?ird ( ! femur )\t /rik+ ! bone4 ,! light] circul> area ( ! l>g] end ( ! %ad[ ( ! projectile %[s t its base is f>!r f ! plate ?an its nose1 :i* 0 probably flatt5$ & b5t by ! rico*et :i* r$uc$ its velocity s z to give x b slight p[] ( p5etration4 ,x is n easy to det]m9e f inspection ( ! plate :i* side ( ! leg lay next to ! plate4 ,) a hi/ory ( ! w\nd ( ! "r ?igh & ) ! outside ( ! leg next to ! plate1 ! projectile mu/ h la9 ne> ! plate on ! outside beh9d ! l[] end ( ! femur1 midway betwe5 ! sk9 & bone4 ,! m>k+s se5 on ! bone are n conc]n$ ) ! w\nd1 z ! same effect 9 ! plate is se5 9 ! areas beside ! bone4 ,! treatm5t is cons]vative2 infection is r>e4 ,illu/ration3 ,plate #ej4 ,,rifle--,,plate #ej4 ,,l[] ,,extremity4 ,gun%ot ,w\nd ( ! ,"r ,?igh1 ) ,lodgm5t ( ! ,bullet ,beh9d ! ,femur4 ,!re is no injury to ! bone4 ,! l>ge diamet]1 %ort5$ l5g?1 & slight d5sity ( ! %ad[ %[ ! bullet to be "s di/ance f & incl9+ t[>d ! plate & lodg$ 9 ! muscles beh9d ! femur1 ne>] ! side away f ! photographic plate4 ,x is difficult to id5tify ! "r or left ?igh f ! radiograph1 b ) ! hi/ory ( ! w\nd 9 ! "r ?igh & ! outside ( ! leg next to ! plate ! ball w\ld lie ne>] ! inside ?an ! outside ( ! ?igh1 ne>] ! surface beh9d ! femur4 ,z ! %ad[ %[s irregul> outl9e & ! location ( ! bullet l[ velocity1 ! w\nd 0 caus$ by a rico*et %ot at v long range4 ,! treatm5t is expectant & ! c\rse naturally favorable4 ,illu/ration3 ,plate #ea4 ,,rifle--,,plate #ea4 ,,l[] ,,extremity4 ,gun%ot ,w\nd ( ! ,?igh1 ) ,lodgm5t ( ! ,missile4 ,z !re is no injury to ! bone1 ! bullet is n de=m$4 ,its p5etrat+ p[] 0 n great en\gh to c>ry x ?r\gh ! tissue s x mu/ h /ruck ! leg at extreme range :5 its en]gy 0 almo/ sp5t4 ,! actual l5g? ( ! bullet is #a4be in*es2 ! l5g? ( ! %ad[ is ab\t #a4ej in*es4 ,! increas$ l5g? & ! relatively slight d5sity ( ! %ad[ indicate ! bullet to be "s di/ance f ! plate4 ,! case hi/ory places ! w\nd 9 ! "r ?igh1 & ! po/]ior surface ( ! leg lay next to ! photographic plate4 ,z ! d5sity ( ! %ad[ is n great] ?an ! ?icke/ portion ( ! bone1 ! bullet probably lies 9 front ( ! bord] ( ! out] tub]osity ( ! femur4 ,al?\gh ! surgeon's diagnosis _h to be made f ! only available plate1 !re is some?+ ( a speculative elem5t 9 ^! d$uctions1 because if ! reaction 9 ! knee jo9t prev5t$ ! pati5t f ext5d+ ! leg ! increas$ l5g? ( ! bullet %ad[ c\ld be acc\nt$ = by ?is position1 :i* w\ld p]mit ! bullet to lie beh9d ! bone & yet f> en\gh f ! plate to acc\nt = ! %ad[ enl>gem5t4 ,! nose ( ! bullet is at ! epiphyseal l9e1 :i* is %[n 9 ! femur4 ,illu/ration3 ,plate #eb4 ,,rifle--,,plate #eb4 ,,l[] ,,extremity4 ,gun%ot ,fracture ( ! ,upp] ,%aft ( ! ,femur4 ,! c\rse ( ! bullet 0 ant]opo/]ior & pi]c$ ! axis ( ! %aft ( ! femur ) ?ree radiat+ l9es ( fracture1 result+ f ! p]=at+ action ( ! bullet /rik+ ! bone at long range & ) greatly r$uc$ en]gy4 ,?is plate %[s ! lat]al sep>ation ( l>ge fragm5ts1 :i* is typical ( gun%ot w\nds ( long range4 ,su* w\nds are usually n infect$4 ,em]g5cy treatm5t is antiseptic dress+ & coaptation ) ext5sion & tempor>y spl9t1 s t x may support ! bone = transportation & may be easily removable at place ( cont9u$ treatm5t4 ,9 ^! cases ) lat]al sep>ation ( fragm5ts1 x is imp]ative to supplem5t ext5sion ) pressure 9 a l9e p]p5dicul> to ! long axis ( ! femur4 ,illu/ration3 ,plate #ec4 ,,rifle--,,plate #ec4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,%aft ( ! ,femur ) ,lodgm5t ( ! ,bullet4 ,! c\rse ( ! bullet 0 ant]o-po/]ior & diagonally inw>d f ! ant]o-ext]nal bord] ( upp] ?ird ( ! ?igh4 ,a ?9 longitud9al fragm5t 0 split (f )\t transv]se fracture4 ,! missile /ruck ! ?igh aft] its en]gy _h be5 greatly r$uc$ by rico*et+ z a result ( /rik+ a resi/+ object :i* flatt5$ its nose & 8set up0 its body1 z %[n by ! wavy outl9es ( ! %ad[s4 ,! d5se & normal-size %ad[ %[s ! bullet to be ne> ! plate & probably 9 ! muscles sup]ficially beh9d & bel[ ! less] tro*ant]4 ,z ! prom95t outl9e ( ! less] tro*ant] %[s t ! leg 0 9 ext]nal rotation :5 ! negative 0 made1 x is evid5t t1 ) ! rotation back to ! anatomical position1 ! projection ( ! %ad[ ( ! bullet w\ld fall close to or 9 l9e ) ! %aft ( ! femur2 ! position ( ! bullet is beh9d ! femur4 ,! treatm5t is cons]vative1 ) no tr\ble to be expect$ f infection4 ,illu/ration3 ,plate #ed4 ,,rifle--,,plate #ed4 ,,l[] ,,extremity4 ,gun%ot ,fracture ( ! ,l[] ,end ( ! ,%aft ( ! ,femur4 ,! c\rse ( ! bullet 0 ant]opo/]ior ?r\gh ! axis ( ! femur4 ,sev]al l>ge fragm5ts :i* 7 n displac$ 7 sep>at$ by ! =ce ( impact4 ,! sep>ation ( ! fragm5ts & ! ov]rid+ ( ! ends ( ! proximal & di/al l>ge fragm5ts 7 due to be>+ bodily weight or to muscul> contraction4 ,! projectile caus+ ! w\nd 0 mov+ ) ! velocity ( mid range4 ,! w\nd ( exit 0 n lac]at$4 ,! em]g5cy treatm5t is antiseptic dress+ & tempor>y spl9t immobilization4 ,p]man5t dress+1 ) ext5sion & lat]al compression1 is ! rule4 ,infection 9 su* cases is frequ5t ow+ to lack ( facilities = prop] dress+ on ! field4 ,results 9 sav+ life & limb are g5]ally good4 ,illu/ration3 ,plate #ee4 ,,rifle--,,plate #ee4 ,,l[] ,,extremity4 ,gun%ot ,fracture ( ! ,l[] ,?ird ( ! ,%aft ( ! ,femur4 ,! c\rse ( ! bullet 0 diagonally ant]opo/]ior1 ) a velocity ne> mid range1 )\t caus+ mu* displacem5t ( fragm5ts4 ,! w\nd ( entrance & exit w\ld be almo/ ! same 9 appe>ance4 ,treatm5t & results w\ld be simil> to case %[n on plate #ed4 ,_m ( ^! w\nds are infect$1 due1 no d\bt1 to ! difficulties ( arrang+ a clean fir/-aid dress+ & effect+ satisfactory immobilization dur+ ! fir/ /age ( transportation4 ,infection f clo?+ c>ri$ into ! w\nd is r>e1 z ! fairly high velocity ( ! bullet causes a spread+ ( ! fib]s )\t division or pun*$-out section be=e ! bullet4 ,z a rule ! infect$ cases ( ?is class recov]$ )\t loss ( limb4 ,amputation 0 v r>e4 ,illu/ration3 ,plate #ef4 ,,rifle--,,plate #ef4 ,,l[] ,,extremity4 ,gun%ot ,fracture ,bel[ ! ,middle ( ! ,femur1 ) ,lodgm5t ( ! ,bullet ,ne> ! ,fracture4 ,! c\rse ( ! projectile 0 transv]se4 ,! long splitt+ fracture1 ) few l>ge fragm5ts & ! lodg$ unde=m$ missile1 indicate t ! injury to ! bone 0 caus$ by ! missile /rik+ ! bone ) l>ge cross section or at an incl9$ angle s t all ( ! rema9+ en]gy ( ! projectile at long range 0 absorb$ by ! bone4 ,_h ! po9t ( ! ball /ruck ! bone ) ! same en]gy1 x w\ld h produc$ small] fragm5ts & might !n h pass$ beyond ! bone4 ,! normal size ( ! diamet]1 slightly %ort5$ l5g?1 great] d5sity ( ! po9t ( ! %ad[1 %[s ! bullet to lie beh9d ! bone ) its nose po9t+ slightly backw>d4 ,! actual l5g? ( ! bullet is #a4be in*es3 ! l5g? ( ! %ad[ is #a in*4 ,treatm5t & results w\ld be ab\t ! same z 9 plates #di & #ej4 ,illu/ration3 ,plate #eg4 ,,rifle--,,plate #eg4 ,,l[] ,,extremity4 ,gun%ot ,fracture ,ab\t ! ,middle ( ! ,femur1 ) ,lodgm5t ( ! ,fragm5ts ( a ,de=m$ ,bullet4 ,! c\rse ( ! missile 0 transv]se4 ,all ( ! rema9+ en]gy ( ! ret>d$ velocity ( ! %ort range ( a rico*et %ot 0 /opp$ by ! bone ) ! result ( a long splitt+ fracture1 & ! lodgm5t ( "o l>ge & a few small fragm5ts ( ! missile4 ,! small not*$ metal fragm5t ly+ to ! "r ( ! upp] bone fragm5t is a small b5t piece ( ! jacket1 deta*$ f ! greatly de=m$ lead core1 :i* c be fa9tly se5 ly+ beh9d ! l[] end ( ! left side ( ! upp] bone fragm5t4 ,! treatm5t is ext5sion ) lat]al compression1 al?\gh ?is case1 %[+ by callus =mation advanc+ convalesc5ce1 reveals v bad position4 ,results z to life & limb are favorable 9 su* cases1 b "s de=mity is to be expect$4 ,x %\ld be not$ t ?is is a case f ,gulhan ,hospital1 ! be/ milit>y hospital 9 ,con/ant9ople1 :]e ! surgical s]vice1 "u ,pr(4 ,wiet+ ,pa%a1 0 skillfully conduct$4 ,illu/ration3 ,plate #eh4 ,,rifle--,,plate #eh4 ,,l[] ,,extremity4 ,gun%ot ,fracture ( ! ,l[] ,end ( ! ,femur4 ,! c\rse ( ! bullet 0 ant]opo/]ior4 ,! long1 oblique1 splitt+ fracture )\t sep>ate fragm5ts indicates ! long range ( ! missile 9 l[ velocity4 ,! w\nd 0 infect$ z is indicat$ by ! dra9age tubes 9 place4 ,! well-advanc$ callus =mation indicates e/abli%$ convalesc5ce4 ,results are favorable = recov]y ) only fair position & "s %ort5+4 ,x may be obs]v$ t ?is is also a case f ,gulhan ,hospital4 ,illu/ration3 ,plate #ei4 ,,rifle--,,plate #ei4 ,,l[] ,,extremity4 ,gun%ot ,w\nd ( ! ,left ,knee-,jo9t1 ) ,lodgm5t ( ! ,missile 9 ! ,jo9t4 ,! c\rse ( ! bullet 0 transv]se1 ent]+ ! capsule po/]ior to ! patella )\t injury to ! bone4 ,z its %ad[ projection is almo/ circul>1 ! bullet mu/ be /&+ almo/ on its end po9t+ t[>d ! plate ) its long axis almo/ p>allel to ! l9e ( projection4 ,z ! fibul> side ( ! leg lay next to ! plate & z ! only slightly enl>g$ %ad[ ( ! bullet indicates x to be ne> ! plate1 its position is 9 ! jo9t ne> ! fibul> side4 ,z ! bullet is unde=m$ & its p5etrat+ p[] v slight1 its velocity 0 t ( extreme range4 ,! em]g5cy treatm5t1 is1 ( c\rse1 a simple antiseptic dress+ ) ! leg held 9 ! mo/ com=table position by muscul> action4 ,! subsequ5t treatm5t is removal ( ! bullet :5 prop] surgical conditions obta94 ,illu/ration3 ,plate #fj4 ,,rifle--,,plate #fj4 ,,l[] ,,extremity4 ,gun%ot ,fracture ( ! ,tibia & ,fibula1 ) ,lodgm5t ( ! ,missile4 ,! c\rse ( ! bullet 0 diagonal f )9 outw>d & backw>d ab\t ! middle ( ! leg1 ) ! impact tang5tial on ! tibia & direct on ! fibula4 ,! bullet lies j beh9d ! tibia4 ,x is app>5t t ! bullet has be5 greatly de=m$ & t its jacket has be5 badly torn f ! core4 ,! =ce ( impact on ! object f :i* x rico*et$ mu/ h be5 contribut$ by ! velocity ( %ort range1 :i* r$uc$ ! /rik+ en]gy s greatly t ! bullet 0 lodg$ by ! resi/ance ( ! tibia & fibula4 ,! w\nd 0 n infect$1 & callus =mation %[s t repair has begun4 ,! treatm5t 9 su* cases1 )\t infection1 is non9t]f]5ce4 ,! lodgm5t ( ! missile ne$ n prejudicate ! prognosis1 & c]ta9ly ! additional damage 9 ! se>* = ! bullet is n w>rant$1 except "u special indications4 ,illu/ration3 ,plate #fa4 ,,rifle--,,plate #fa4 ,,l[] ,,extremity4 ,gun%ot ,fracture ( ! ,l[] ,ends ( ! ,tibia & ,fibula4 ,! c\rse ( ! bullet 0 transv]se1 ) ! velocity ( mid-range4 ,! fragm5tation ( ! fibula1 ly+ close to ! sk91 w\ld produce consid]able lac]ation 9 ! w\nd ( exit4 ,! treatm5t is cons]vative4 ,infection w\ld dep5d almo/ entirely ^u ! integrity ( ! fir/ dress+s & immobilization4 ,results %\ld be favorable1 ) c>e 9 subsequ5t treatm5t4 ,illu/ration3 ,plate #fb4 ,,rifle--,,plate #fb4 ,,l[] ,,extremity4 ,gun%ot ,fracture ( ! ,upp] ,?ird ( ! ,tibia1 ) ,l>ge ,longitud9al ,fragm5t4 ,! c\rse ( ! bullet 0 ant]opo/]ior & slightly diagonal f )\t inw>d ?r\gh ! %aft ( ! tibia4 ,! injury 0 due to ! en]gy ( impact ( a bullet1 9 ! high velocity ( %ort range1 /rik+ ! axis ( ! diaphysis1 9 :i* ! great] "p ( its en]gy 0 exp5d$ 9 pu%+ away a wall ( ! canal4 ,convalesc5ce is well e/abli%$ )\t infection1 z %[n by callus =mation4 ,! treatm5t 9 su* cases is inv>iably cons]vative1 ) ! removal ( su* fragm5ts z may be deta*$ by suppuration & seque/ration4 ,illu/ration3 ,plate #fc4 ,,rifle--,,plate #fc4 ,,l[] ,,extremity4 ,gun%ot ,w\nd ( ! ,middle ( ! ,tibia1 ) ,few ,l>ge ,fragm5ts4 ,! c\rse ( ! bullet 0 transv]se f )\t inw>d4 ,! direct impact ( ! bullet1 9 high velocity ( %ort range1 has produc$ ! typical 8,x0 fracture due to ! radiat+ l9es ( =ce4 ,! w\nd 0 infect$1 z is %[n by ! dra9age tubes 9 ! w\nd4 ,! em]g5cy treatm5t 9 su* cases is simple antiseptic dress+ & tempor>y spl9t immobilization4 ,! subsequ5t treatm5t is ! managem5t ( ! infection4 ,! results 9 su* cases are favorable4 ,illu/ration3 ,plate #fd4 ,,rifle--,,plate #fd4 ,,l[] ,,extremity4 ,gun%ot ,fracture ( ! ,tibia4 ,! c\rse ( ! bullet 0 diagonal1 f )\t inw>d & f be=e backw>d ?r\gh ! middle ( ! tibia4 ,small p>ticles ( metal h lodg$ at ! site ( ! fracture--a condition :i* nev] occurs 9 a rifle w\nd ) ! jacket ( ! bullet intact1 :ile x is ! inv>iable accompanim5t ( a %rapnel w\nd ( a bone4 ,x is inf]r$ t ! jacket ( ! bullet 9 ?is case 0 damag$ by rico*et1 or t "s metal p>ticles f ! object aga9/ :i* ! bullet rico*et$ 7 c>ri$ into ! w\nd1 z "s o!r small pieces ( metal are se5 9 areas di/ant f ! seat ( fracture4 ,z ! fragm5ts are small & n displac$1 ! velocity ( ! missile1 at lea/ t ( mid-range1 0 almo/ suffici5t to p]=ate ! bone )\t fracture4 ,illu/ration3 ,plate #fe4 ,,rifle--,,plate #fe4 ,,l[] ,,extremity4 ,gun%ot ,fracture ( ! ,tibia4 ,! c\rse ( ! bullet 0 transv]se1 f )9 outw>d1 /rik+ ! bone ne> ! out] bord] ) ! velocity ( mid or long range1 produc+ long fissures )\t sep>ation ( fragm5ts4 ,! safety p91 ( c\rse1 lies 9 ! dress+s & on ! side away f ! plate1 z %[n by its some:at indef9ite outl9e & increas$ l5g?4 ,! w\nds ( entrance & exit are practically ! same4 ,! treatm5t 9 su* cases is t ( a simple fracture1 except = ! managem5t ( an occasional infection1 & ! results are favorable4 ,illu/ration3 ,plate #ff4 ,,rifle--,,plate #ff4 ,,l[] ,,extremity4 ,gun%ot ,fracture ( ! ,middle ( ! ,tibia1 ) ,lodgm5t ( ! ,missile4 ,! c\rse ( ! bullet 0 transv]se1 f )\t inw>d1 /rik+ on ! side ( ! %aft ( ! tibia4 ,! bullet 0 s badly damag$ by rico*et t only a portion ( x 0 ! cause ( ?is w\nd4 ,! range 0 %ort1 if n close1 z ! missile aft] /rik+ a resi/+ object ) =ce en\gh to break itself reta9$ en\gh en]gy 9 a fragm5t ( less ?an half its mass to cause a long fissure fracture1 ) ! sep>ation ( small] fragm5ts4 ,! treatm5t is non9t]f]5ce1 except = infection1 :i*1 contr>y to :at might be expect$ f presumable contam9ation f ! object f :i* x rico*et$1 does n occur m frequ5tly 9 rico*et ?an direct w\nds ) lodgm5t ( ! projectile4 ,illu/ration3 ,plate #fg4 ,,rifle--,,plate #fg4 ,,l[] ,,extremity4 ,gun%ot ,fracture ( ! ,l[] ,?ird ( ! ,tibia4 ,! c\rse ( ! bullet1 ) r$uc$ en]gy ( long range1 0 ant]opo/]ior1 /rik+ ! inn] bord] ( ! bone & pun*+ out a circul> area ( small fragm5ts ) a s+le transv]se l9e ( fracture4 ,! w\nd ( exit 0 slightly l>g] ?an ! w\nd ( entrance4 ,! treatm5t is cons]vative4 ,infection is n probable if em]g5cy dress+ is clean4 ,illu/ration3 ,plate #fh4 ,,rifle--,,plate #fh4 ,,l[] ,,extremity4 ,gun%ot ,fracture ( ! ,l[] ,?ird ( ! ,tibia4 ,! c\rse ( ! bullet 0 diagonally ant]opo/]ior1 f )\t inw>d1 /rik+ ! int]nal bord] ( ! ant]ior surface ( ! bone1 & p>tially splitt+ (f fragm5ts f ! side ) a p]=at+ effect4 ,! range ( ! %ot 0 long4 ,! d5se & irregul> %ad[s to ! "r ( ! fracture are caus$ by ! mat]ial us$ 9 dress+ & indicate a slight infection4 ,! small %ad[s on ! tibial side are n a "p ( ! w\nd1 b are due to opaque mat]ial caught 9 ! dress+4 ,illu/ration3 ,plate #fi4 ,,rifle--,,plate #fi4 ,,l[] ,,extremity4 ,gun%ot ,fracture ( ! ,l[] ,end ( ! ,tibia4 ,! c\rse ( ! bullet 0 transv]se1 f )\t inw>d1 ?r\gh ! l[] end ( ! bone1 ) a pi]c+ effect & a fissur+ ( ! upp] fragm5t4 ,! velocity 0 t ( %ort range4 ,! w\nd ( exit w\ld be slightly l>g] ?an t ( entrance1 z "s small fragm5ts c be se5 ext5d+ along ! tract ( ! missile f ! l9e ( transv]se fracture t[>d ! int]nal bord] ( ! leg4 ,!re 0 no lac]ation ( ! w\nd ( exit4 ,! w\nd 0 clean4 ,! treatm5t is cons]vative4 ,results %\ld be favorable4 ,infection w\ld dep5d mo/ probably ^u ! asepsis ( ! fir/ dress+4 ,illu/ration3 ,plate #gj4 ,,rifle--,,plate #gj4 ,,l[] ,,extremity4 ,gun%ot ,fracture ( ! ,tibia1 ) ,lodgm5t ( ! ,missile4 ,! c\rse ( ! bullet 0 f )9 outw>d1 /rik+ ! po/]ior surface ( ! tibia ab\t #b in*es above ! ankle1 & caus+ a slight crack 9 ! bone at ! po9t :]e its c\rse 0 deflect$4 ,! velocity 0 t ( extreme range1 z ! :olly normal outl9e ( ! projectile & ! slight p5etration indicates t its en]gy 0 almo/ entirely lo/ 9 flight & n by rico*et4 ,! %>p outl9es ( ! l[] bord] ( ! fibula & ! ext]nal bord] ( ! articul> surface ( ! l[] end ( ! tibia indicate ! position ( ! fibula z next to ! photographic plate4 ,! bullet lies at a v slight angle ) ! plate1 z is %[n by ! curv$ outl9e ( its base1 :i* condition alone w\ld give a projection %ad[ some:at %ort] ?an ! bullet4 ,b z ! %ad[ is actually some:at long] ?an ! bullet 7ab\t "o-eigh? in*1 or "o-t5? its l5g?71 ! position ( ! bullet is "s di/ance f ! plate & mo/ probably lies beh9d ! tibia1 at ! inside ( ! fibula4 ,illu/ration3 ,plate #ga4 ,,rifle--,,plate #ga4 ,,l[] ,,extremity4 ,gun%ot ,fracture ( ! ,fibula4 ,! c\rse ( ! bullet 0 ant]opo/]ior ?r\gh ! l[] ?ird ( ! leg1 /rik+ ! fibula squ>ely1 pass+ ?r\gh ! bone ) a p]=at+ effect1 accompani$ by slight fragm5tation & ) a r$uc$ velocity ( long range4 ,! w\nds ( entrance & exit w\ld be almo/ ! same 9 appe>ance4 ,asepsis 9 su* cases is ! almo/ inv>iable rule1 & ! treatm5t aft] ! simple dress+ is t ( a simple fracture4 ,illu/ration3 ,plate #gb4 ,,rifle--,,plate #gb4 ,,l[] ,,extremity4 ,gun%ot ,fracture ( ! ,ankle4 ,! c\rse ( ! bullet 0 ant]opo/]ior1 /rik+ ! fibula f beh9d ) a velocity ( long range1 & caus+ "s slight fragm5tation )\t displacem5t ( ! fragm5ts4 ,! jo9t ar*itecture is slightly di/urb$4 ,! jo9t mortice is a bit wid5$ by ! ext]nal deflection ( ! ext]nal malleolus1 :i* p]mits a slight outw>d rotation ( ! a/ragalus4 ,z ! dang]s ( infection are usually escap$1 ! treatm5t is t = ,pott's fracture4 ,illu/ration3 ,plate #gc4 ,,rifle--,,plate #gc4 ,,l[] ,,extremity4 ,gun%ot ,w\nd ( ! ,heel1 ) ,lodgm5t ( ! ,missile4 ,! c\rse ( ! bullet 0 f beh9d =w>d ?r\gh ! ins]tion ( ! t5do ,a*illis & its lodgm5t along ! out] bord] ( ! os calcis4 ,!re 0 no injury to ! bone4 ,! pa? ( ! bullet is %[n by ! slight mottl+ above ! po/]ior extremity ( ! os calcis4 ,! nose ( ! bullet is slightly de=m$ by rico*et at long range4 ,! v slight p5etration & ! slight de=mity ( ! nose ( ! bullet indicates a velocity ( extreme range ( bo? impact ( ! rico*et & ( ! w\nd4 ,! %>p outl9e ( fibula & ! base ( fif? metat>sal %[s ! fibula to be next to ! plate4 ,! only slight enl>gem5t & squ>e base ( ! %ad[ ( ! bullet %[ x to be p>allel to ! plate1 or at "r angles to ! l9e ( projection1 & ?us indicate its position to be on ! fibula side ( ! os calcis1 bel[ ! tip ( ! ext]nal malleolus4 ,illu/ration3 ,plate #gd4 ,,rifle--,,plate #gd4 ,,l[] ,,extremity4 ,gun%ot ,w\nd ( ! ,heel4 ,?is is ! same case z %[n 9 plate #fi1 b ) ! %ad[ project$ f above d[nw>d in/ead ( f side to side1 z 9 ! prec$+ plate4 ,! int]pretation ( ! %ad[s 9 ! prec$+ plate is ?us confirm$4 ,z ! heel lay on ! plate1 ! projectile at a %>p angle ) ! plane ( ! plate1 sev]al in*es f>!r f ! plate ?an 9 ! prec$+ radiograph1 & ) ! l9e ( projection at ab\t "r angles to ! long axis ( ! projectile1 ! %ad[ projection is consid]ably enl>g$4 ,illu/ration3 ,plate #ge4 ,,%rapnel--,,plate #ge4 ,,head4 ,gun%ot ,fracture ( ! ,v]tex1 ) ,intracranial ,lodgm5t ( ! ,missile4 ,w\nd ( entrance1 left ant]ior p>ietal region4 ,w\nd ( exit1 none4 ,! missile left a few small fragm5ts spatt]$ on ! bone at po9t ( entrance1 ) a slight de=mation ( ! ball due to ?is cause1 z %[n 9 ! plate4 ,! di/9ct outl9e & normal size ( ! ball %[s x to be v ne> ! plate & on ! left side ( ! head1 :ile ! enl>g$ & blurr$ image ( ! safety p9 %[s its position to be on ! side ( ! head f>!r away f ! plate4 ,em]g5cy treatm5t is antiseptic dress+ only4 ,subsequ5t treatm5t is direct$ to fragm5ts & depression1 )\t se>* = ball4 ,septic condition might indicate "s lat] int]f]5ce4 ,results 9 su* cases are favorable if w\nd is n infect$4 ,illu/ration3 ,plate #gf4 ,,%rapnel--,,plate #gf4 ,,head4 ,gun%ot ,fracture ( ! ,v]tex4 ,w\nd ( entrance1 upp] "r & mid-p>ietal region4 ,w\nd ( exit1 none4 ,! missile probably 0 de=m$ be=e /rik+ ! skull1 ^u :i* x 0 fragm5t$ by impact1 ) sev]al fragm5ts foll[+ ! int]nal cont\r ( ! v]tex & o!rs rema9+ spatt]$ ab\t ! w\nd ( entrance4 ,x is probable t a l>g] mass ( ! %rapnel ball1 caus+ ! great] damage to ! bone1 rico*et$ out ( ! w\nd4 ,! di/9ct outl9e ( ! c5tral safety p9 & ! less def9ite image ( ! %rapnel fragm5ts %[ ! w\nd to h be5 f>!r f ! plate ?an ! safety p9 on ! left side4 ,! treatm5t is expectant1 )\t se>* = ! missile4 ,results 9 su* cases are favorable1 except = dang] ( infection4 ,illu/ration3 ,plate #gg4 ,,%rapnel--,,plate #gg4 ,,head4 ,gun%ot ,fracture ( ,zygoma1 ) ,lodgm5t ( ! ,missile 9 ! ,zygomatic ,fossa4 ,w\nd ( entrance1 ext]nal bord] ( "r supra-orbital ridge4 ,w\nd ( exit1 none4 ,a few metallic fragm5ts are se5 :]e ! missile lodg$ ne> ! po9t ( impact ) ! bone4 ,! treatm5t is expectant4 ,removal ( ! ball f its sup]ficial location is indicat$ if ! w\nd is infect$4 ,result 9 su* cases is favorable4 ,illu/ration3 ,plate #gh4 ,,%rapnel--,,plate #gh4 ,,head4 ,gun%ot ,fracture ( ! ,ma/oid ,process4 ,w\nd ( entrance1 upp] po/]ior *eek1 9 front ( ! e>4 ,w\nd ( exit1 po/]ior to ma/oid process1 lac]at$4 ,! c\rse ( ! missile 0 tang5tial1 ) ! damage limit$ to ! out] table ( ! ma/oid4 ,! metal p>ticles scrap$ (f ( ! ball by its contact ) ! bone m>k ! site ( ! w\nd4 ,treatm5t is expectant4 ,results are favorable4 ,illu/ration3 ,plate #gi4 ,,%rapnel--,,plate #gi4 ,,head4 ,gun%ot ,fracture ( ! ,left ,maxilla1 ) ,lodgm5t ( ! ,missile 9 ! ,neck ,beh9d ! ,angle ( ! ,jaw4 ,w\nd ( entrance1 bel[ infraorbital ridge1 ) c\rse ?r\gh ! m\?4 ,w\nd ( exit1 none4 ,missile left a few small metallic fragm5ts spatt]$ on ! bone at ! po9t ( entrance4 ,!re is slight m>k ( de=mity ( ! missile caus$ by its contact ) ! bone1 %[n 9 its %ad[ 9 ! plate4 ,! di/9ct outl9e & normal size ( ! ball %[s x to h be5 on ! side next to & ne> ! plate4 ,treatm5t indicat$ is expectant4 ,results 9 su* cases are favorable1 z seat ( probable infection is readily accessible4 ,9 ?is p>ticul> case1 recov]y foll[$ ) ! ball left 9 situ1 )\t caus+ ! pati5t tr\ble en\gh to induce him to p]mit int]f]5ce4 ,illu/ration3 ,plate #hj4 ,,%rapnel--,,plate #hj4 ,,head4 ,gun%ot ,fracture ( ! ,ant]ior ,table ( ! ,frontal ,s9us1 ) ,lodgm5t ( ! ,missile 9 ! ,po/]ior ,n>es4 ,w\nd ( entrance1 ov] ! left int]nal sup] supra-orbital ridge1 ) c\rse d[nw>d1 slightly backw>d1 & slightly to ! left po/]ior n>es4 ,w\nd ( exit1 none4 ,! di/9ct outl9e & practically normal size ( ball %[s t ! pati5t's face 0 sup]impos$ on ! photographic plate1 z ! ant]ior location ( ! missile 0 suspect$4 ,! slight de=mity ( ! ball is due to ! impact ) ! bone4 ,?is p]sonal case 0 receiv$ f ! s]vice ( ,pr(4 ,de ,page1 ( ! ,belgian ,r$ ,cross ,mission1 at ,jo% ,ke%la ,hospital1 ,con/ant9ople1 aft] an op]ation = infections ( ! frontal s9us1 9 :i* ! ant]ior table 0 entirely remov$1 ) free dra9age into ! po/]ior n>es1 be=e ! radiograph 0 made or ! exact location ( ! ball suspect$4 ,! missile is se5 9 ! n>es--v ne> ! face--probably 9 ! middle meatus1 9 ! inf]ior turb9ates1 aga9/ ! septum1 deviat$ by its lodgm5t4 ,convalesc5ce 0 f9ally e/abli%$ & ! frontal-s9us w\nd practically clos$ :51 )\t any subjective symptoms1 an ob/ruction 0 objectively det]m9$ 9 ! left po/]ior n>es1 sugge/+ ! radiograph4 ,! pati5t 0 s entirely free f any symptoms ( ! lodg$ missile t he wisely refus$ any m$dlesome int]f]5ce4 ,he 0 dis*>g$ ) s9us w\nd clos$ v rem>kably )\t indication = pla/ic op]ation & ) no symptoms4 ,illu/ration3 ,plate #ha4 ,,%rapnel--,,plate #ha4 ,,head4 ,gun%ot ,fracture ( ,ant]ior ,table ( ! ,p>ietal ,bone & ! ,vom]1 ) ! ,lodgm5t ( ! ,missile 9 ! ,po/]ior ,n>es4 ,?is plate is a side view ( ! case 9 plate ,no4 #hj1 %[+ ! ant]o-po/]ior location ( ! ball4 ,! indef9ite outl9e & enl>g$ size ( ! ball %[s ! ball to h be5 f>!r away f ! plate ?an 9 plate #hj4 ,illu/ration3 ,plate #hb4 ,,%rapnel--,,plate #hb4 ,,upp] ,,extremity4 ,gun%ot ,w\nd ( ! ,%\ld]1 ) ,lodgm5t ( ! ,missile4 ,! c\rse ( ! missile 0 transv]se f ! po/]ior surface ( ! great] tub]osity ( ! hum]us to ! int]nal bord] ( ! scapula1 di/ribut+ small metallic fragm5ts along its pa?4 ,!re is no injury to ! bone4 ,! remnant ( ! ball has pass$ beh9d ! scapula & lies ne> its sup]ior angle4 ,! treatm5t 9 su* cases is1 ( c\rse1 cons]vative1 ) no s]i\s consequ5ces expect$ f infection4 ,illu/ration3 ,plate #hc4 ,,%rapnel--,,plate #hc4 ,,upp] ,,extremity4 ,gun%ot ,w\nd ( ! ,%\ld]1 ) ,lodgm5t ( ! ,missile4 ,! c\rse ( ! ball 0 transv]se ?r\gh ! po/]ior bord] ( ! deltoid muscle )\t contact ) ! bone1 :i* w\ld h be5 reveal$ by small p>ticles ( lead scrap$ (f f ! ball4 ,! actual size1 normal outl9e1 & great d5sity ( ! %ad[ ( ! ball %[ t x lay next to ! plate & t x is1 !re=e1 lodg$ po/]ior & mesial to ! gl5oid portion ( ! scapula4 ,! treatm5t is non9t]f]5ce unless removal be indicat$ by pa91 impairm5t ( function1 or infection4 ,! results %\ld always be good4 ,illu/ration3 ,plate #hd4 ,,%rapnel--,,plate #hd4 ,,upp] ,,extremity4 ,gun%ot ,w\nd ( ! ,%\ld]1 ) ,lodgm5t ( ! ,missile4 ,! c\rse ( ! bullet 0 f be=e backw>d & upw>d ?r\gh ! deltoid to ! ant]ior surface ( ! head ( ! hum]us4 ,! missile is n ! conv5tional %rapnel ball1 :i* is sph]ical & ab\t "o-half in* 9 diamet]1 = ! %ad[ %[s a l>g] axis 9 "o direction ) p>allel sides1 too symmetrical to be attribut$ to de=mation4 ,! balli/ic conditions are ^? ( %rapnel4 ,! missile /ruck ! bone an in* or two bel[ ! po9t ( lodgm5t4 ,its pa? is %[n by p>ticles ( metal4 ,pa9 or int]f]5ce ) function w\ld be cause = int]f]5ce 9 subsequ5t treatm5t1 :i* o!rwise w\ld be expectant4 ,illu/ration3 ,plate #he4 ,,%rapnel--,,plate #he4 ,,upp] ,,extremity4 ,gun%ot ,w\nd ( ! ,%\ld]1 ) ,lodgm5t ( ! ,missile4 ,! missile lies beh9d ! head ( ! hum]us1 "u conditions simil> to ! cases %[n 9 plates #hc & #hd4 ,! position ( ! hall is indicat$ by ! outl9e & dep? ( %ad[ ( ! normal size ( a %rapnel ball4 ,! ball mu/ !re=e be v ne> ! plate & beh9d ! head ( ! hum]us4 ,!re is no injury to ! bone4 ,! slight de=mity ( ! ball 0 caus$ by rico*et be=e x caus$ ! w\nd1 z no p>ticles ( lead are se5 on ! bone to acc\nt = ! impact ( ! missile4 ,illu/ration3 ,plate #hf4 ,,%rapnel--,,plate #hf4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,clavicle4 ,! ball rang$ f be=e backw>d & upw>d1 comm9ut+ ! out] half ( ! clavicle4 ,! fragm5ts h be5 remov$4 ,! p>ticles ( metal :i* m>k ! pa? ( ! ball lie 9 front ( ! acromion process ( ! scapula1 because lack ( d5sity & indi/9ct outl9e ( ! %ad[s %[ !m to be f>!r f ! photographic plate ?an ! sp9e ( ! scapula :i* re/$ on ! plate1 escap+ ! imm95t dang] ( w\nd+ ! subclavian vessels4 ,! treatm5t is cons]vative & results are favorable4 ,illu/ration3 ,plate #hg4 ,,%rapnel--,,plate #hg4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,hum]us4 ,! missile /ruck ! bone & caus$ a long1 splitt+ fracture1 ) "s fragm5tation ( ! proximal fragm5t4 ,! w\nd c\ld h be5 caus$ by ei!r a rico*et$ rifle bullet or by a de=m$ %rapnel ball1 ei!r projectile be+ ! l[ velocity ( long range4 ,^! conditions are m common to %rapnel w\nds1 b ! appe>ance ( ! l>g] metal fragm5t leads to ! suspicion t x is a piece ( ! jacket ( a rifle bullet4 ,! w\nd 0 n infect$1 & convalesc5ce is well advanc$1 z is indicat$ by ! call\s =mation4 ,illu/ration3 ,plate #hh4 ,,%rapnel--,,plate #hh4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,hum]us1 ) ,lodgm5t ( ! ,missile4 ,! missile /ruck ! %aft ( ! hum]us f an ant]ior & ext]nal direction & caus$ a long diagonal splitt+ fracture ) fragm5tation1 9 :i* ! bone absorb$ all ( ! en]gy ( ! missile at ! seat ( fracture4 ,! missile lies 9 ! ant]ior surface ( ! hum]us1 9 two fragm5ts2 ! small]1 mu* less di/9ct1 is se5 ab\t an in* above ! l>g]4 ,! w\nd is n infect$1 & convalesc5ce is well e/abli%$1 z is indicat$ by ! call\s =mation1 ) ov]lapp+ ( ! fragm5ts4 ,! treatm5t 9 su* cases is cons]vative & ! results are favorable4 ,illu/ration3 ,plate #hi4 ,,%rapnel--,,plate #hi4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,hum]us4 ,! c\rse ( ! missile 0 f beh9d =w>d & outw>d1 /rik+ ! bone on ! po/]ior surface1 caus+ a fracture ) fragm5tation1 & lac]at+ ! w\nd ( exit ) fragm5ts ( bones & ) its own de=mation4 ,! w\nd ( exit is indicat$ 9 ! plate4 ,! w\nd is infect$4 ,fragm5ts ( ! missile lie on ! po/]ior surface ( ! bone1 z indicat$ by _! d5se %ad[ & di/9ct outl9e4 ,! treatm5t 9 su* cases is cons]vative & ! results are favorable4 ,illu/ration3 ,plate #ij4 ,,%rapnel--,,plate #ij4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,left ,hum]us4 ,! c\rse ( ! missile 0 transv]se f )\t inw>d1 ) a transv]se fracture & fragm5tation4 ,?is w\nd might h be5 caus$ by ei!r a %rapnel ball or a de=m$ rifle bullet1 b ! di/ribution ( ! metallic fragm5ts r indicate ! c\rse ( a %rapnel ball4 ,! metallic fragm5ts lie f>!r f ! plate ?an ! safety p9 ( ! dress+1 :i*1 !re=e1 lies beh9d ! bone & ! fragm5ts ( ! missile lie 9 front4 ,! treatm5t 9 su* cases is cons]vative & ! results are favorable4 ,! subsequ5t c\rse may indicate int]f]5ce = mal-union4 ,illu/ration3 ,plate #ia4 ,,%rapnel--,,plate #ia4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,left ,hum]us4 ,! c\rse ( ! missile has be5 f )\t inw>d4 ,! fragm5ts ( metal m>k+ ! pa? ( ! missile lie f>!r f ! plate on ! out] ?an on ! inn] side4 ,?is w\ld indicate ! =m] to be 9 front ( ! bone & ! latt] to be beh9d4 ,! w\nd c\ld h be5 caus$ by ei!r a de=m$ rifle bullet or by a %rapnel ball1 b ! di/ribution ( metallic fragm5ts along ! track ( ! missile r indicates ! ag5t to h be5 a %rapnel ball4 ,! case is simil> 9 c\rse & results to t %[n 9 ! prec$+ plate #ij4 ,illu/ration3 ,plate #ib4 ,,%rapnel--,,plate #ib4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,"r ,hum]us1 ) ,lodgm5t ( ! ,missile4 ,! missiles1 %rapnel balls de=m$ by rico*et1 7 multiple1 ) a c\rse f )\t inw>d & diagonally d[nw>d4 ,! /reaks ( metal p>ticles along ! seat ( fracture indicates ! pa? ( a %rapnel ball or fragm5t f ! po9t ( impact to ! l[] fragm5t ( ! fracture1 :]e sev]al de=m$ %rapnel fragm5ts are lodg$4 ,multiple w\nds by %rapnel are common4 ,! w\nds ( entrance 7 small4 ,!re 0 no w\nd ( exit4 ,! w\nd 0 n infect$4 ,?is is ano!r evid5ce t does n def5d ! inf]5ce t rico*et$ missiles are prone to introduce elem5ts ( infection into a w\nd4 ,! pla/] dress+ does n seem to meet ! indications = support ( ! fracture4 ,! treatm5t is cons]vative 9 su* cases4 ,results are favorable4 ,illu/ration3 ,plate #ic4 ,,%rapnel--,,plate #ic4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,"r ,hum]us4 ,! c\rse ( ! missile 0 transv]se1 f )\t inw>d & d[nw>d1 /rik+ ! %aft ( ! bone squ>ely & produc+ a *>act]i/ic 8butt]fly0 fracture1 ) a sep>ation ( ! fragm5ts4 ,! exposure 0 made ) ! uln> side ( ! arm next to ! plate1 indicat$ by ! cle> outl9e ( ! int]nal condyle & ! olecranon4 ,! ne>ly normal size ( ! %ad[ ( ! %rapnel ball %[s x to be ne> ! plate1 & !re=e to lie on ! inside ( ! hum]us4 ,! irregul> outl9e ( ! ball & ! metallic fragm5ts spatt]$ ab\t indicate t ! ball 0 de=m$ by ! deta*m5t ( fragm5ts on direct impact ) ! bone4 ,! w\nd is n infect$4 ,! treatm5t is cons]vative 9 su* cases & ! results are good4 ,illu/ration3 ,plate #id4 ,,%rapnel--,,plate #id4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,"r ,hum]us4 ,! c\rse ( ! missile 0 f beh9d =w>d1 caus+ a transv]se fracture ( ! hum]us ) "s fragm5tation4 ,! w\nd is 9 a /ate ( e/abli%$ convalesc5ce1 ) consid]able sep>ation ( ! ends ( ! l>ge fragm5ts & )\t infection1 %[n by ! =mation ( callus & by an attempt at union 9 faulty position4 ,! trail ( ! metallic fragm5ts ( ! missile f beh9d =w>d & _! location ne> ! ant]ior surface ( ! arm indicate ! c\rse ( ! missile1 ei!r a rifle bullet or a %rapnel ball--mo/ probably ! latt]1 z ! lead core ( ! rifle ball1 protect$ by ! jacket1 does n break up into z _m small p>ticles z does ! %rapnel ball4 ,! missile 0 de=m$ by rico*et be=e /rik+ ! bone4 ,! e>ly treatm5t 9 su* cases is cons]vative1 al?\gh ! subsequ5t c\rse may indicate int]f]5ce = malposition4 ,! results are favorable4 ,illu/ration3 ,plate #ie4 ,,%rapnel--,,plate #ie4 ,,upp] ,,extremity4 ,gun%ot ,w\nd ( ! ,hum]us1 ) ,lodgm5t ( ! ,missile4 ,! c\rse ( ! missile 0 f be=e backw>d4 ,! missile consi/$ ( two l>ge fragm5ts ( a ri*o*et$ %rapnel ball1 almo/ sp5t 9 en]gy be=e /rik+ ! arm1 z its p5etration 0 j en\gh to pass ?r\gh ! s(t p>ts & /rike ! hum]us1 caus+ a fissure )\t sep>ation ( fragm5ts4 ,! w\nd 0 clean4 ,! treatm5t 9 su* cases is naturally cons]vative4 ,! epiphysis ( ! olecranon be+ s di/9ct & %[+ no fusion1 indicates ! y\? ( ?is soldi]1 ^: age c\ld n h be5 m ?an #af ye>s4 ,illu/ration3 ,plate #if4 ,,rifle--,,plate #if4 ,,upp] ,,extremity4 7a7 ,gun%ot ,fracture ( ! ,left ,hum]us--7b7 ,gun%ot ,fracture ( ! ,left ,elb[4 ,! missile 0 a rifle bullet ) ! r$uc$ velocity ( long range1 pass+ transv]sely along ! articulations ( ! elb[1 fragm5t+ ! radius & ulna & fissur+ ! hum]us ?r\gh bo? condyles4 ,! em]g5cy treatm5t is antiseptic dress+ & immobilization1 ) prompt transportation to ! base4 ,subsequ5t treatm5t is cons]vative1 ) prop] immobilization4 ,results z to limb are favorable1 ) probable loss ( function ( ! elb[4 ,illu/ration3 ,plate #ig4 ,,%rapnel--,,plate #ig4 ,,upp] ,,extremity4 ,gun%ot ,w\nd ( ! ,"r ,elb[4 ,! c\rse ( ! missile 0 sup]ficial1 d[nw>d & outw>d f above ! int]nal condyle ( ! "r hum]us to ! w\nd ( exit ov] ! int]nal bord] ( ! ulna4 ,metal fragm5ts ( ! missile h lodg$ aga9/ ! tip ( ! olecranum1 ) no fracture & ) no damage to ! jo9t4 ,! l[ velocity ( ! missile1 produc+ s slight a bone injury & ! track ( lead p>ticles along ! l9e ( contact ) ! bones det]m9es x to h be5 a %rapnel ball4 ,! w\nd 0 n infect$4 ,! treatm5t 9 su* cases is naturally cons]vative & ! results are v favorable4 ,illu/ration3 ,plate #ih4 ,,%rapnel--,,plate #ih4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,"r ,elb[1 ) ,lodgm5t ( ! ,missile4 ,! c\rse ( ! ball 0 f be=e backw>d1 /rik+ ! l[] end ( ! hum]us squ>ely above & int]nal to ! ext]nal condyle & splitt+ (f ! condyles ) a l9e ( fracture ext5d+ ?r\gh ! capitellum1 )\t mu* sep>ation ( ! fragm5t4 ,z ! impact 0 direct1 ! en]gy produc+ su* effect 0 t ( l[ velocity4 ,! great radiographic p5etration %[n 9 ?is plate gives ! %ad[s ( ! ball great di/9ctness & def9ite outl9e1 especially 9 ! l9e ( fracture1 al?\gh its opposite bord] is n 9 su* %>p contra/4 ,?is appe>ance1 toge!r ) ! v slight enl>gem5t1 leads to ! suspicion t ! ball lies po/]iorly1 b a l>g] metal fragm5t1 bel[ ! ball1 is less cle> & sugge/s a position ant]ior to ! bone4 ,) ! po/]ior surface ( ! arm next to ! plate & ) b little diff]5ce 9 ! di/ance f ! plate to ei!r ! ant]ior or po/]ior surface ( ! bone1 x is n easy to det]m9e ! location ( ! ball 9 ! ant]opo/]ior direction1 b x w\ld seem to be on ! ant]ior surface ( ! bone4 ,! w\nd is n infect$4 ,! treatm5t is cons]vative & results favorable4 ,! subsequ5t c\rse w\ld probably indicate ! removal ( a =eign body f a site s ne> ! jo9t4 ,illu/ration3 ,plate #ii4 ,,%rapnel--,,plate #ii4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,"r ,elb[1 ) ,lodgm5t ( ! ,missile4 ,same w\nd z 9 plate #ih4 ,! %>p hold] ( ! great] sigmoid cavity & ! head ( ! radius fully obscur$ by ! coracoid process indicate1 t 9 ?is exposure1 ! uln> side ( ! arm 0 next to ! plate4 ,) ?is condition & ! enl>g$ %ad[ ( ! ball1 ! latt] mu/ lie a little di/ance away f ! plate1 &1 actually1 on ! radial side ( ! hum]us4 ,! position ( ! ball 9 ! ant]opo/]ior l9e is manife/1 & its position confirms ! d$uctions made !refrom 9 ! prec$+ plate 7#ih74 ,illu/ration3 ,plate #ajj4 ,,%rapnel--,,plate #ajj4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,elb[4 ,! prim>y condition ( ?is w\nd is n manife/ f ! appe>ance ( ! plate1 :i* reveals only a de/ruction ( ! jo9t by fracture & an advanc$ /age ( infection1 involv+ ! fragm5ts & l[] end ( ! %aft ( ! hum]us1 z indicat$ by ! r>efaction ( ^! p>ts4 ,sev]al fragm5ts ( ! missile are 9 evid5ce2 x is probable t o!rs h escap$ ) dra9age4 ,dra9age tubes are se5 9 ! l[] arm & upp] =e>m4 ,! prim>y cons]vative treatm5t has be5 cont9u$ ?r\gh two or ?ree mon?s4 ,! case is f ,gulhan ,milit>y ,hospital1 :]e ! sci5tific "* ( surgical s]vice already ref]r$ to mu/ lead to ! inf]5ce t all ! surgical indications h be5 met 9 ! managem5t ( ! case4 ,illu/ration3 ,plate #aja4 ,,%rapnel--,,plate #aja4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,left ,radius & ,ulna1 ) ,lodgm5t ( ! ,missile4 ,! c\rse ( ! missile 0 f )9 outw>d1 /rik+ ! ulna a glanc+ bl[ j above ! /yloid process1 fractur+ ! ant]ior surface1 & !n /rik+ ! int]nal bord] ( ! radius & caus+ a slight not*+ fracture ) a longitud9al fissure4 ,! =e>m lies 9 sup9ation1 ) its po/]ior surface next to ! plate4 ,z ! outl9e ( ! missile1 z well z ( ! bone1 is blurr$1 !re is n en\gh diff]5tiation 9 ! %ad[s to indicate ! ant]ior or po/]ior location ( ! missile ) ref]5ce to ! radius4 ,! %rapnel ball /ruck ! bone ) l[ velocity1 z all ( its rema9+ en]gy1 absorb$ by ! two small bones1 caus$ little damage & practically no displacem5t ( fragm5ts4 ,! w\nd 0 n infect$4 ,! treatm5t 9 su* cases is1 ( c\rse1 cons]vative4 ,results are uni=mly good4 ,illu/ration3 ,plate #ajb4 ,,%rapnel--,,plate #ajb4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,"r ,radius4 ,a fragm5t$ %rapnel ball1 c\rs+ f )\t inw>d1 /ruck ! upp] ?ird ( ! %aft ( ! radius & caus$ a gre5-/ick fracture4 ,a fragm5t ( ! ball1 l>g] ?an ^? se5 9 ! plate1 inflict$ ! great] damage & escap$ ?r\gh ! w\nd ( exit1 to be se5 bel[ ! l>ge fragm5t on ! left ( ! plate4 ,! olecranon process ( ! "r ulna re/s on ! photographic plate1 ) ! =e>m 9 semipronation1 s t ! %ad[ ( ! radius falls ne>ly 9 l9e ) t ( ! ulna4 ,) ! =e>m re/or$ to ! anatomical position1 ! spatt]$ metallic fragm5ts1 n[ se5 ly+ ov] & to ! left ( ! radius1 w\ld !n be %[n ly+ on ! out] bord] ( & po/]ior to ! radius1 except = ! upp] "r metallic fragm5t1 n[ ly+ ov] ! ulna1 :i* w\ld be se5 ly+ ov] ! ant]ior surface ( ! radius4 ,! six pellets se5 9 ! l[] =e>m h n contribut$ to ! injury ( ! bone4 ,_! d5sity & indef9ite outl9e indicate a position 9 ! =e>m opposite to ! side next to ! plate4 ,) ! =e>m 9 sup9ation !y w\ld appe> 9 _! real position1 9 front ( ! ulna & on ! outside ( ! radius4 ,illu/ration3 ,plate #ajc4 ,,%rapnel--,,plate #ajc4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,"r ,radius4 ,! missile 9 its c\rse f beh9d =w>d & f above d[nw>d left a trail ( its metal p>ticles along ! l9e ( its fir/ contact until ! bone yield$ to ! pressure 9 a transv]se fracture4 ,! arm lies 9 slight pronation ) ! longitud9al ridges ( ! dorsal surface ( ! ulna1 %[n di/9ctly next to ! photographic plate4 ,! upp] end ( ! l[] radial fragm5t1 %[n z ov]ly+ ! ulna1 is incl9$ =w>d 9 ! anatomical position4 ,! metal p>ticles are on ! out] & po/]ior bord] ( ! radius4 ,! treatm5t 9 su* cases is cons]vative4 ,results z to function are unc]ta94 ,illu/ration3 ,plate #ajd4 ,,%rapnel--,,plate #ajd4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,ulna4 ,! c\rse ( ! missile 0 tang5tial along side ( ! upp] end ( ! ulna & int]nal condyle ( ! hum]us1 ) a splitt+ effect on ! ulna1 :i* =m$ ?ree fragm5ts by break+ (f ! olecranon1 & "o lat]al fragm5t f ! %aft ( ! bone )\t displacem5t4 ,! l9e ( metallic p>ticles %[s ! pa? ( ! ball 9 its slight contact ) ! bones1 beg9n+ on ! side ( ! ulna & ext5d+ along ! side ( ! int]nal condyle f :]e ! ball escap$ ?r\gh ! sk94 ,! w\nd1 n infect$1 0 treat$ z simple fracture4 ,a few f9e l9es on ! plate above ! fracture are due to scrat*es on ! negative4 ,results 9 su* cases %\ld be good4 ,illu/ration3 ,plate #aje4 ,,%rapnel--,,plate #aje4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,"r ,metac>pus4 ,! c\rse ( ! missile 0 f ! out] bord] ( ! hypo?ne> em95ce diagonally d[nw>d ?r\gh ! palm1 lodg+ aga9/ ! second metac>pal bone ) fracture ( la/ f\r metac>pals4 ,! metal p>ticles are n se5 on ! f\r? & fif? metac>pals because ! viol5ce at ^! po9ts 0 transmitt$ ?r\gh s(t p>ts1 b ! projectile sp5t its rema9+ en]gy directly aga9/ ! second & ?ird metac>pals4 ,! palm ( ! h& 0 next to ! photographic plate1 z indicat$ by ! imm$iate contact ( ! ?umb4 ,! %ad[ ( ! bones is n d5se1 b 9 deep contra/ ) ! %ad[s ( ! ball & metal fragm5ts1 :i* are s cle>ly outl9$ ) ! ball ( normal size t ! ball is ?us %[n to lie on ! palm> side ( ! h&4 ,! treatm5t is cons]vative1 ) judici\s int]f]5ce :5 opportunity %all (f] = removal ( ! missile4 ,illu/ration3 ,plate #ajf4 ,,%rapnel--,,plate #ajf4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,left ,metac>pus1 ) ,lodgm5t ( ! ,missile4 ,! palm ( ! h& lies next to ! plate4 ,! ball is v slightly enl>g$ & ! small metal fragm5ts are indi/9ct1 indicat+ t !y & ! ball lie on ! back ( ! h&4 ,! ball /ruck ! ?ird knuckle & lodg$ b5ea? ! sk9 betwe5 ! f\r? & fif? metac>pals1 fractur+ bo? bones )\t displacem5t ( fragm5ts4 ,9 ! rec5t w\nd ! condition w\ld be app>5t1 b aft] days ( inflammatory reaction & infection1 ! swell+ is too great to make any det]m9ation by palpation4 ,! treatm5t is removal ( ! missile4 ,good results regul>ly foll[4 ,illu/ration3 ,plate #ajg4 ,,%rapnel--,,plate #ajg4 ,,upp] ,,extremity4 ,gun%ot ,fracture ( ! ,left ,metac>pus1 ) ,lodgm5t ( ! ,missile4 ,! h& lies ) its uln> side next to ! plate1 z is indicat$ by ! %>p outl9e ( ! swoll5 hypo!n> em95ce1 ne>] ! plate ?an ! ?umb1 ) ! enl>g$1 poorly def9$1 & r>efi$ %ad[ ( its metac>pal & phalanges4 ,z ! normal size ( ! balls & ! cle> outl9e ( ! metal fragm5ts mu/ place !m almo/ 9 contact ) ! plate1 ! ball is locat$ ne> ! fif? metac>pal4 ,z ?is is ! same case z is %[n 9 plate #ajf1 ! conclusions drawn f ea* plate are confirm$ by ! o!r4 ,! w\nd is infect$1 z indicat$ by ! swell+ ( ! palm4 ,! treatm5t is removal ( ! missile1 ) managem5t ( ! infection4 ,illu/ration3 ,plate #ajh4 ,,%rapnel--,,plate #ajh4 ,,upp] ,,extremity4 ,gun%ot ,w\nd ( ! ,left ,h&1 ) ,lodgm5t ( ! ,missile4 ,! %ad[ ( ! h& is %[n ) ! palm next to ! plate1 z indicat$ by ! small1 well-def9$ outl9e ( ! fir/ metac>pal ly+ )9 ! outl9e ( ! l>g] & less-def9$ %ad[ ( ! second metac>pal4 ,! ?ird f+] is flex$ at ! fir/ phalangeal jo9t1 & ! end ( ! second phalanx is outl9$ 9 deep] %ad[1 ) its long axis v]tical to ! plate4 ,! position raises ! fir/ f+] f ! plate & v slightly enl>ges ! size ( ! %ad[ ( ! bullet1 al?\gh x reta9s its %>p outl9e4 ,! %ad[ ( ! ball be+ v ne>ly ! normal size1 ! ball lies on ! palm> side ( ! ?ird metac>po-phalangeal jo9t4 ,x ent]$ ! h& on ! out] bord] ( ! base ( ! fir/ f+]1 & left a fragm5t ( metal on its slight contact ) ! bone4 ,! ball 0 de=m$ by rico*et be=e /rik+ ! h&1 ) almo/ completely sp5t velocity4 ,! w\nd is infect$4 ,! treatm5t is ! managem5t ( infection4 ,illu/ration3 ,plate #aji4 ,,%rapnel--,,plate #aji4 ,,upp] ,,extremity4 ,multiple ,gun%ot ,w\nds ( ! ,"r ,h& & ,=e>m1 ) ,fracture ( ! ,metac>pus & ,phalanges & ,lodgm5t ( ! ,missile4 ,! h& lay ) ! palm> surface next to ! plate4 ,! di/9ct outl9e ( ! small metal fragm5ts & ! natural size ( ! %ad[ ( ! unde=m$ %rapnel ball %[ t !y lay on ! ant]ior side ( ! metac>pus4 ,! arrangem5ts ( ! metal p>ticles & bone fragm5ts & ! indication ( ! po9t ( entrance ( "o w\nd on ! out] bord] ( ! metac>pal ( ! ?umb indicate ! c\rse ( ! balls to h be5 f ! radial to ! ulna side ( ! palm4 ,! unde=m$ ball1 !n1 lies1 mo/ probably1 9 front ( ! second metac>pal4 ,! de=m$ ball %[s1 9 its enl>g$ %ad[ & n s di/9ct 9 outl9e z ! normal ball1 t x is on ! dorsal surface ( ! ?ird & f\r? metac>pals4 ,! unde=m$ ball caus$ ! fracture ( ! phalanx & metac>pal ( ! ?umb2 ! de=m$ ball fractur$ ! neck ( ! ?ird metac>pal2 a ball :i* escap$ f ! w\nd & t\*$ ! base ( ! fir/ phalanx ( ! middle f+] & fractur$ ! fir/ phalanx ( ! little f+]2 & ano!r ball1 :i* glanc$ along ! ant]ior surface ( ! l[] end ( ! %aft ( ! radius & left a deposit ( metal to m>k its c\rse1 also escap$ f ! uln> bord] ( ! =e>m at a po9t indicat$ 9 ! plate4 ,f\r balls 7 conc]n$ ) ?is w\nd2 two ( !m h lodg$ ) "s damage & two o!rs h escap$1 aft] inflict+ a slight injury4 ,multiple %rapnel w\nds are common4 ,x may be said t ! great] ! numb] ( balls lodg$ 9 a giv5 area ! less ! di/ance ( ! plane f ! apex ( ! cone ( disp]sion ( a %rapnel dis*>ge4 ,sev]al %rapnel balls1 lodg$ 9 a small area )\t caus+ mu* damage or exhibit+ mu* p[] ( p5etration1 indicate l[ velocity at close range ( %rapnel balls on dis*>ge f ! %rapnel envelope4 ,9 a p]sonal case1 eight %rapnel balls 7 remov$ f a =e>m4 ,illu/ration3 ,plate #aaj4 ,,%rapnel--,,plate #aaj4 ,,*e/4 ,gun%ot ,w\nd ( ! ,*e/1 ) ,lodgm5t ( ! ,missile 9 ! ,lung4 ,! po/]ior *e/ wall is next to ! plate1 z ! po/]ior rib %ad[s are mu* m di/9ct & mu* small] ?an ! %ad[s ( ! ant]ior ribs4 ,! %ad[ ( ! ball is blurr$1 :i* %[s t x mov$ ) respiration & is1 !re=e1 probably 9 ! lung4 ,! %ad[ is only slightly enl>g$ & is fairly d5se1 :i* indicates x to be n f> f ! ribs &1 !re=e1 9 ! po/]ior portion ( ! lung4 ,! treatm5t ( su* cases is cons]vative2 infection is n common2 hmo?orax pleurisy1 empyema1 pneumonia1 & pulmon>y abscess are mo/ frequ5t complications1 nam$ 9 ! ord] ( frequ5cy4 ,pulmon>y abscess is v r>e4 ,pneumonia 0 se5 9 a p]sonal case4 ,illu/ration3 ,plate #aaa4 ,,%rapnel--,,plate #aaa4 ,,*e/4 ,gun%ot ,w\nd ( ,*e/1 ) ,lodgm5t ( ! ,missile ,sup]ficially4 ,:ile ! missile is n a %rapnel ball1 x pres5ts simil> conditions & does n ne$ to be sep>ately classifi$4 ,! v]tebral bord] ( ! scapula is di/9ctly %[n 9 light %ad[1 indicat+ its position ne> ! plate4 ,! outl9e ( ! missile is s di/9ct & ! %ad[ s d5se t x mu/ lie ne> ! plate1 & is locat$ sup]ficially 9 ! infrasp9atus fossa4 ,illu/ration3 ,plate #aab4 ,,%rapnel--,,plate #aab4 ,,*e/4 ,gun%ot ,w\nd ( ! ,*e/1 ) ,fractur$ ,rib & ,lodgm5t ( ! ,missile 9 ! ,axilla4 ,! back ( ! pati5t lay on ! plate1 z is indicat$ by ! normal size ( ! ribs beh9d & ! exagg]at$ outl9e 9 front4 ,! ball /ruck ! six? rib beh9d & caus$ a fracture at ! angle4 ,x !n cont9u$ its c\rse to ! axilla4 ,! normal size ( ! %ad[ ( ! ball indicates t x lies sup]ficially beh9d ! head ( ! hum]us4 ,! w\nd ( ! rib 0 infect$ sup]ficially1 & ! secretion ( ! w\nd c>ri$ away ! mo/ ( ! metal p>ticles :i* ! ball 9 /rik+ deposit$ on impact4 ,illu/ration3 ,plate #aac4 ,,%rapnel--,,plate #aac4 ,,*e/4 ,gun%ot ,w\nd ( ! ,*e/1 ) ,lodgm5t ( ! ,missile 9 ! ,axilla4 ,!re is no w\nd ( ! bone4 ,! ball lies 9 ! axilla1 beh9d1 n close to1 ! plate1 because ! d5sity ( ! %ad[ is n v great & ! size is slightly enl>g$4 ,! di/ance f ! plate is probably t ( ! mid-axill>y l9e4 ,! w\nd is n infect$4 ,pa9 & impair$ movem5t ( ! arm sugge/$ localization ( ! missile & indicate removal 9 ! subsequ5t c\rse ( treatm5t4 ,illu/ration3 ,plate #aad4 ,,%rapnel--,,plate #aad4 ,,*e/4 ,gun%ot ,w\nd ( ! ,*e/1 ) ! ,lodgm5t ( ! ,missile 9 ! ,axilla4 ,! po/]ior *e/ wall lay next to ! plate4 ,! almo/ normal size ( ! %ad[ ( ! ball indicates t x lies ne> ! plate1 & ! blurr$ outl9e %[s t x has mov$ ) ! *e/ 9 respiration4 ,! ball lies1 !re=e1 9 ! po/]ior axilla ne> ! middle ( ! out] bord] ( ! scapula1 imb$d$ 9 ! ?oracic muscles4 ,! treatm5t is expectant4 ,su* w\nds are r>ely infect$4 ,pa9 or impairm5t ( function only w\ld indicate removal ( ! missile f a clean w\nd4 ,illu/ration3 ,plate #aae4 ,,%rapnel--,,plate #aae4 ,,pelvis4 ,gun%ot ,fracture ( ! ,cre/ ( ! ,"r ,ilium1 ) ,lodgm5t ( ! ,missile4 ,z ! w\nd 0 receiv$ :ile ! soldi] 0 ly+ prone1 ! c\rse ( ! missile 9 ! body 0 f above d[nw>d1 /rik+ ! cre/ ( ! ilium1 on :i* x 0 fragm5t$1 & trail+ its fragm5ts z f> d[n z ! great tro*ant]4 ,! injury to ! ilium 0 a cru%+ fracture1 ) ! displacem5t ( small fragm5ts f ! ant]o-sup]ior sp9e4 ,z ! sacrum 0 next to ! photographic plate1 ! missile1 judg+ f its indi/9ct %ad[1 lies f>!r f ! plate & 9 front ( ! bone4 ,! relative di/9ctness ( ! l>ge fragm5t se5 on ! w+ ( ! ilium indicates its probable position to be on ! outside ( ! ilium4 ,! trail ( ! small] metal fragm5ts lies betwe5 ! ant]o-sup]ior sp9e & ! great tro*ant]1 ant]ior to ! plane ( ! femur4 ,! treatm5t 9 su* cases is always cons]vative4 ,illu/ration3 ,plate #aaf4 ,,%rapnel--,,plate #aaf4 ,,l[] ,,extremity4 ,gun%ot ,w\nd ( ! ,?igh1 ) ,lodgm5t ( ! ,missile4 ,) ! po/]ior aspect ( ! ?igh ly+ next to ! plate1 ! v greatly enl>g$ %ad[ ( ! de=m$ %rapnel ball indicates t x lies a relatively great di/ance f ! plate1 s t its location c be det]m9$ to be ne> ! int]nal bord] ( ! adductor muscles1 ant]iorly1 & bel[ ! transv]se plane ( ! less] tro*ant]4 ,illu/ration3 ,plate #aag4 ,,%rapnel--,,plate #aag4 ,,l[] ,,extremity4 ,gun%ot ,w\nd ( ! ,?igh1 ) ,lodgm5t ( ! ,missile4 ,) ! sacrum ly+ next to ! plate1 ! normal size1 cle> outl9e1 & d5se %ad[ ( ! %rapnel ball indicates its position to be ne> ! plate4 ,! location c be r\ghly e/imat$ z ! sup]ficial gluteal region1 ext]nal to ! ramus ( ! is*ium & ne> ! a]ior plane ( ! upp] bord] ( ! acetabul> cavity4 ,illu/ration3 ,plate #aah4 ,,%rapnel--,,plate #aah4 ,,l[] ,,extremity4 ,gun%ot ,w\nd ( ! ,?igh1 ) ,lodgm5t ( ! ,missile4 ,! normal size1 di/9ct outl9e1 & consid]able d5sity ( ! %ad[ ( ! %rapnel ball %[ t x lies v ne> ! plate1 po/]ior to ! bone & 9 ! buttocks1 q sup]ficially4 ,! treatm5t 9 su* cases is always cons]vative4 ,pa9 or impairm5t ( function indicate removal aft] convalesc5ce4 ,illu/ration3 ,plate #aai4 ,,%rapnel--,,plate #aai4 ,,l[] ,,extremity4 ,gun%ot ,fracture ( ! ,femur1 ) ,lodgm5t ( ! ,missile4 ,! direct subtro*ant]ic impact dis9tegrat$ ! missile & deliv]$ all ( its en]gy to ! bone1 ) a result+ transv]se fracture ( ! upp] end ( ! %aft ( ! femur & longitud9al fragm5tation ( ! %aft4 ,! c\rse ( ! %rapnel ball 0 f beh9d =w>d & f above d[nw>d1 z is %[n by ! track ( ! metal fragm5ts & ! lodgm5t ( a l>g] lead fragm5t on ! %aft bel[ ! seat ( fracture4 ,! upp]mo/ l>ge lead fragm5t1 z %[n by ! dep? ( its %ad[1 lies f>!r beh9d ! bone & ne>] to ! photographic plate ?an d ! o!r pieces ( ! ball1 z indicat$ by _! light] %ad[s4 ,all ( ! fragm5ts seem to lie beh9d ! bone4 ,! cons]vative treatm5t ( ?is w\nd is ju/ifi$ by ! attempt at repair1 z indicat$ by ! callus =mation2 b x is manife/1 f ! extremely faulty position1 t ! indication = immobilization & ext5sion 9 /rong abduction 7 n appreciat$4 ,prop] managem5t ( cons]vative treatm5t 9 su* cases gives good results4 ,illu/ration3 ,plate #abj4 ,,%rapnel--,,plate #abj4 ,,l[] ,,extremity4 ,gun%ot ,fracture ( ! ,femur1 ) ,lodgm5t ( ,multiple ,missiles4 ,! position ( ! femur is 9 outw>d rotation1 z %[n by ! full %ad[ ( ! less] tro*ant] & ! vani%+ ( ! great] tro*ant] beh9d ! %\ld] ( ! neck4 ,! two l>g] missiles lie on ! out] side ( ! bone & ! o!rs lie 9 front on ! seat ( fracture4 ,! greatly de=m$ %rapnel balls & ! slight *ipp+ fracture ( ! femur indicate t ! great] portion ( ! /rik+ en]gy ( ! missiles 0 s dissipat$ 9 rico*et t b little =ce 0 left = attack on ! bone4 ,! treatm5t 9 su* cases is expectant & indication r>ely arises = se>* = & removal ( ! missiles4 ,illu/ration3 ,plate #aba4 ,,%rapnel--,,plate #aba4 ,,l[] ,,extremity4 ,gun%ot ,fracture ( ! ,%aft ( ! ,femur1 ) ,lodgm5t ( ! ,missile4 ,! c\rse ( ! %rapnel ball 0 f )9 outw>d1 /rik+ ! femur ) ! en]gy ( high 7%rapnel7 velocity1 ) fragm5tation ( ! missile by impact on ! bone4 ,! l>ge/ fragm5t1 by ! di/9ct outl9e ( its %ad[1 lies close to ! plate & beh9d ! bone2 a small] metal fragm5t has be5 c>ri$ to ! out] bord] ( ! ?igh1 :]e x lies sup]ficially2 ano!r fragm5t lies 9 ! seat ( fracture4 ,! position ( fragm5ts is faulty1 z ! indications = ext5sion & abduction h n be5 :olly met1 al?\gh ?is is a case f ! well-conduct$ s]vice ( ,gulhan ,hospital4 ,! treatm5t 9 su* cases is cons]vative & ! results are good4 ,illu/ration3 ,plate #abb4 ,,%rapnel--,,plate #abb4 ,,l[] ,,extremity4 ,gun%ot ,fracture ( ! ,%aft ( ! ,femur1 ) ,lodgm5t ( ! ,missile4 ,! %rapnel ball1 9 its almo/ directly ant]o-po/]ior c\rse f beh9d =w>d1 has deliv]$ ! en]gy ( high 7%rapnel7 velocity to ! bone1 :i* _h absorb$ x all 9 /opp+ ! missile1 ) a result+ approa* to a butt]fly fracture ) displacem5t ( fragm5ts4 ,! upp] end ( ! l[] fragm5t lies ne>] to ! plate ?an to ! l[] end ( ! upp] fragm5t1 ) ! de=m$ %rapnel ball ly+ beh9d ! latt]1 clos] to ! plate4 ,! treatm5t 9 su* cases is cons]vative1 ) good results to foll[ except z !y may be imp]il$ by infection4 ,illu/ration3 ,plate #abc4 ,,%rapnel--,,plate #abc4 ,,l[] ,,extremity4 ,gun%ot ,fracture ( ! ,femur1 ) ,lodgm5t ( ! ,missile4 ,:ile ! missile 9 ?is case may h be5 o!r ?an a %rapnel ball1 ! fracture is "o produc$ by ! impact ( a missile deliv]+ great /rik+ en]gy1 ) a pr$om9ant cross-section factor 9 its composition4 ,! fragm5ts are due to ! application ( an en]gy 9 :i* ! mass 0 di/ribut$ ov] a relatively l>ge area on bone1 :i* result$ 9 ! displacem5t ( ! l>ge fragm5ts4 ,! treatm5t 9 su* cases is cons]vative4 ,results are favorable2 infection is g5]ally controll$4 ,illu/ration3 ,plate #abd4 ,,%rapnel--,,plate #abd4 ,,l[] ,,extremity4 ,gun%ot ,fracture ( ! ,femur1 ) ,lodgm5t ( ,multiple ,missiles4 ,! direct impact ( two %rapnel balls1 deliv]+ all ( _! en]gy to ! femur1 result$ 9 a fracture ) l>ge fragm5ts4 ,! exposure 0 made ?r\gh a pla/] spl9t1 & %[s a faulty position ) progress+ repair4 ,! treatm5t 9 su* cases is cons]vative1 b ) respect = ! indications to ma9ta9 prop] position ( ! fragm5ts4 ,illu/ration3 ,plate #abe4 ,,%rapnel--,,plate #abe4 ,,l[] ,,extremity4 ,gun%ot ,fracture ( ! ,femur1 ) ,lodgm5t ( ! ,missile4 ,! condition %[n 9 ! plate is ! *>act]i/ic result ( direct impact ( a projectile ( l[ velocity & great sectional area 9 :i* all ( ! en]gy is deliv]$ to ! bone aga9/ :i* x lodges4 ,! di/9ct outl9e & d5se %ad[ ( ! de=m$ missile indicates its position to be beh9d ! bone4 ,! callus =mation indicates ! favorable progress ( repair1 b ) ! fragm5ts 9 faulty position4 ,! treatm5t 9 su* cases is cons]vative1 ) prop] respect to ! pr9ciples ( ma9t5ance ( normal relation ( ! fragm5ts4 ,illu/ration3 ,plate #abf4 ,,%rapnel--,,plate #abf4 ,,l[] ,,extremity4 ,gun%ot ,fracture ( ! ,femur1 ) ,lodgm5t ( ! ,missile4 ,! c\rse ( ! %rapnel ball 0 ant]o-po/]ior1 ) an impact on ! %aft ( ! femur1 :i* fragm5t$ bo? ! ball & bone ?r\gh ! imp>t+ or ! entire /rik+ en]gy ( ! ball to ! bone by ! lodgm5t ( ! ball4 ,! %>p outl9e & d5sity ( ! %ad[s ( ! missile1 9 contra/ ) ! d5se %ad[s ( ! bone1 indicate t ! missile lies clos] to ! plate ?an does ! bone1 al?\gh ! flatt5$ ball does n p]mit a comp>ison betwe5 its %ad[ & ! normal size ( ! ball4 ,! advanc$ /age ( convalesc5ce is %[n by ! =mation ( call\s4 ,! treatm5t 9 su* cases is cons]vative & ! results are good if prop] position c be ma9ta9$4 ,illu/ration3 ,plate #abg4 ,,%rapnel--,,plate #abg4 ,,l[] ,,extremity4 ,gun%ot ,fracture ( ! ,%aft ( ! ,femur4 ,! impact ( ! missile 0 deliv]$ ) ! en]gy ( high 7%rapnel7 velocity at close range1 z is indicat$ by ! signs ( ano!r %rapnel w\nd1 j above ! out] tub]osity 79 ! l[] left corn] ( ! plate71 :]e a deposit ( metallic p>ticle is evid5c$4 ,! fragm5tation ( ! missile1 ?r\gh its contact ) ! bone1 indicates ! great /rik+ =ce ( a missile :i* rico*et$ f ! bone4 ,! g5]al di/ribution ( metallic p>ticles ?r\gh a w\nd ( ?is class indicates c]ta9ly t ! missile 0 unjacket$1 & ! de/ructive =ces %[ t its sectional area 0 relatively l>g]1 i4 e41 a %rapnel ball4 ,! h>d metal jacket ( a rifle bullet w\ld n give (f its p>ticles 9 contact ) ! bone unless x 7 s greatly de=m$ z to h almo/ entirely lo/ its jacket4 ,9 ?is /ate ! en]gy ( a rifle ball mu/ be s greatly r$uc$1 ?r\gh ! viol5ce ( rico*et1 t x w\ld n reta9 en\gh /rik+ =ce to cause its dis9tegration on impact ) ! bone4 ,besides1 "s p>ticles ( ! jacket c\ld be id5tifi$1 z !y are always b5t or twi/$ s t _! "* is recogniz$ 9 ! %ad[4 ,illu/ration3 ,plate #abh4 ,,%rapnel--,,plate #abh4 ,,l[] ,,extremity4 ,gun%ot ,w\nd ( ! ,left ,knee1 ) ,lodgm5t ( ! ,missile 9 ! ,jo9t4 ,! slight enl>gem5t & mod]ate d5sity ( ! %ad[ ( ! projectile indicates a position a %ort di/ance f ! plate4 ,a slight %ad[ dep5d5t f ! ext]nal condyle on ! outside ( ! ball & a metallic m>k+ j outside ( ! upp] cont\r ( ! out] tub]osity indicate an injury to ! jo9t & ! pa? ( ! ball f above ! out] tub]osity into ! jo9t capsule4 ,! probabilities are t ! ball lies betwe5 ! head ( ! tibia & ! patell> not* ( ! femur1 b ! absolute c]ta9ty ( ?is d$uction mu/ be support$ by an exposure 9 a lat]al plane1 :i* is %[n 9 plate #abi4 ,illu/ration3 ,plate #abi4 ,,%rapnel--,,plate #abi4 ,,l[] ,,extremity4 ,gun%ot ,w\nd ( ! ,left ,knee1 ) ,lodgm5t ( ! ,missile 9 ! ,jo9t4 ,z ! fibul> %ad[ is ab\t ! normal size & cle>ly outl9$1 ! fibul> side ( ! leg lay next to ! plate4 ,z ! %ad[ ( ! ball is d5se & n mu* enl>g$1 x mu/ lie ne> ! plate4 ,a light %ad[ 9 front ( ! ball1 :i* %[s ! ant]ior crucial ligam5t1 & a metallic m>k+ above ! patella1 sugge/s ! pa? ( ! ball4 ,z ?is is a lat]al projection ( ! same case t is %[n 9 plate #abh 9 an ant]o-po/]ior projection1 ^! conclusions are ?us v]ifi$4 ,! missile lies 9 ! jo9t capsule betwe5 ! head ( ! tibia1 9 front ( ! sp9e1 & ! patell> not* ( ! femur4 ,z a =eign body 9 ! knee jo9t :i* s]i\sly int]f]es ) its function1 removal is indicat$ :5 surgical facilities are at h&4 ,! results 9 su* cases are usually good4 ,illu/ration3 ,plate #acj4 ,,%rapnel--,,plate #acj4 ,,l[] ,,extremity4 ,gun%ot ,w\nd ( ! ,left ,knee1 ) ,lodgm5t ( ! ,missile 9 ! ,jo9t4 ,! l9e ( projection ( ! %ad[ is direct$ obliquely f beh9d1 focuss$ on ! int]nal aspect ( ! knee1 ) ! fibula next to ! plate4 ,z ! %ad[ ( ! %rapnel ball is mu* enl>g$ & n v d5se1 ! ball mu/ lie "s di/ance f ! plate & away f ! fibul> side ( ! jo9t4 ,z ! di/ances ?r\gh ! knee jo9t are ab\t ! same 9 all cases & z %rapnel balls are approximately ! same size1 x is evid5t t ! ball lies f>!r away f ! plate ?an x does 9 plate #abi1 :]e x is ab\t ! middle ( a transv]se l9e ?r\gh ! jo9t4 ,x mu/ lie1 !re=e1 sup]ficially betwe5 ! head ( ! tibia & ! int]nal condyle ( ! femur4 ,removal is indicat$ "u favorable surgical conditions4 ,infection ( ! jo9t may occasionally indicate dra9age & removal z em]g5cy treatm5t4 ,results1 except = infection1 are good4 ,illu/ration3 ,plate #aca4 ,,%rapnel--,,plate #aca4 ,,l[] ,,extremity4 ,gun%ot ,w\nd ( ! ,knee1 ) ,lodgm5t ( ! ,missile4 ,t ! knee is n fully ext5d$ is %[n by ! exagg]at$ outl9e ( ! tibial head4 ,! enl>g$ & only fair d5sity ( ! %ad[ indicates t ! %rapnel ball lies "s di/ance away f ! plate4 ,z ! bone is n injur$1 ! missile mu/ lie ei!r 9 front ( or beh9d ! femur1 & its enl>g$ %ad[ %[s ! position to be 9 front ( ! femur1 j above ! articul> surface1 & probably )9 ! reflection ( ! capsul> ligam5t4 ,a comp>ison ) ! size ( ! %ad[s ( ! balls %[n 9 plates #abh & #acj w %[ ?is "o to be great] ?an ! =m] & less ?an ! latt]1 & s x mu/ be> ab\t ! same relation 9 ! di/ance f ! plate4 ,?is w\ld acc\nt = ! location 9 front in/ead ( beh9d ! femur4 ,! treatm5t is cons]vative1 & removal is indicat$ :5 function is di/urb$4 ,illu/ration3 ,plate #acb4 ,,%rapnel--,,plate #acb4 ,,l[] ,,extremity4 ,gun%ot ,w\nd ( ! ,knee1 ) ,lodgm5t ( ! ,missile4 ,! fibul> side ( ! leg lay next to ! photographic plate1 z %[n by ! enl>g$ fa9t] outl9e ( ! int]nal tub]osity4 ,! %ad[ ( ! %rapnel ball is nei!r z normal 9 size z t ( ! ext]nal condyle nor z exagg]at$ z t ( ! int]nal condyle1 & ! position is probably nei!r z close to ! plate z ! =m] nor z f> away z ! latt]4 ,! missiles lie ab\t ! middle ( ! ant]ior surface ( ! l[] end ( ! femur1 above ! articul> surface4 ,illu/ration3 ,plate #acc4 ,,%rapnel--,,plate #acc4 ,,l[] ,,extremity4 ,gun%ot ,w\nd ( ! ,"r ,knee1 ) ,lodgm5t ( ! ,missile4 ,! ball /ruck ! out] condyle j above ! articul> surface ) only en\gh en]gy to damage & slightly crack ! bone4 ,! injury to ! bone & ! metallic m>k ( ! impact c be se5 j above ! out] bord] ( ! articul> c>tilage ( ! out] condyle4 ,illu/ration3 ,plate #acd4 ,,%rapnel--,,plate #acd4 ,,l[] ,,extremity4 ,gun%ot ,w\nd ( ! ,left ,knee1 ) ,lodgm5t ( ! ,missile4 ,! out] tub]osity lay next to ! photographic plate1 ) ! knot 9 ! localiz+ wire on ! inside ( ! leg & f>!r away f ! plate4 ,! l9e ( projection is transv]sely ?r\gh ! tub]osities4 ,! %ad[ ( ! ball1 z x is some:at enl>g$1 n %>ply def9$1 & ( m$ium d5sity1 mu/ lie ab\t midway betwe5 ! l9es ( ! localiz+ wire or 9 ! popliteal space j above & betwe5 ! tub]osities1 mu* ne>] ! popliteal surface ?an ! bone4 ,an accurate localization ( ! ball 9 a transv]se l9e1 h[ev]1 w\ld require an exposure ( ano!r plate 9 an ant]o-po/]ior l9e1 b 9 ?is actual case ! localization ( ! ball _h to be made f ?is s+le plate1 z only "o exposure 0 made4 ,! ball /ruck ! bord] ( ! popliteal space ( ! femur j above ! tub]osity1 )\t en]gy en\gh to cause a fracture1 de=m ! ball1 or ev5 to leave1 z a m>k ( contact1 metal p>ticles ( ! ball4 ,illu/ration3 ,plate #ace4 ,,%rapnel--,,plate #ace4 ,,l[] ,,extremity4 ,gun%ot ,w\nd ( ! ,left ,leg1 ) ,lodgm5t ( ! ,missile4 ,! po/]ior surface ( ! leg lay next to ! plate1 z %[n by ! outl9e ( ! head ( ! fibula1 b any e/imate ( di/ance f ! plate1 bas$ on dep? ( ! %ad[s1 is ( little value because !re is no contra/ betwe5 localiz+-wire %ad[s 9 front ( & beh9d ! leg4 ,! slightly enl>g$ %ad[ ( ! ball indicates x to be f>!r f ! plate ?an x w\ld be if x lay beh9d ! fibula4 ,z ! %ad[s ( ! metal fragm5ts on ! tibia are n %>p en\gh to indicate _! position to be ne> ! plate1 ! ball has lodg$ ant]iorly betwe5 ! tibia & fibula aft] rico*et+ f ! ant]ior surface ( ! tibia4 ,! ball1 be+ unde=m$1 /ruck ! tibia ) s little =ce t x b>ely p5etrat$ ! sk94 ,! reaction ( infection 9 su* w\nds makes a diagnosis on physical exam9ation difficult & indicates radiography4 ,illu/ration3 ,plate #acf4 ,,%rapnel--,,plate #acf4 ,,l[] ,,extremity4 ,gun%ot ,w\nd ( ! ,leg1 ) ,lodgm5t ( ! ,missile4 ,! leg lay ) its po/]ior surface next to ! photographic plate4 ,! enl>g$ %ad[ ( ! ball & ! blurr$ outl9es ( ! metal fragm5ts require !m to be "s di/ance f ! plate & !re=e on ! ant]ior surface ( ! tibia4 ,! impact has be5 f )9 outw>d ) s little en]gy t ! ball only t\*$ ! int]nal bord] ( ! tibia & lodg$ b5ea? ! sk94 ,)\t ! reaction ( inflammation & infection1 diagnosis c\ld be made by palpation1 b ext5sive swell+ indicates radiography4 ,illu/ration3 ,plate #acg4 ,,%rapnel--,,plate #acg4 ,,l[] ,,extremity4 ,gun%ot ,fracture ( ! ,tibia & ,fibula4 ,! fibul> side ( ! leg lay next to ! plate1 z ! di/9ct & n exagg]at$ outl9es ( ! fibula c be se5 9 ! d5se %ad[ ( ! tibia4 ,! w\nd1 z indicat$ by ! call\s tissue1 is %[n 9 a /ate ( repair1 aft] ! l>g] deta*$ fragm5ts ( ! fracture _h be5 remov$4 ,! w\nd 0 caus$ by a missile c>ry+ consid]able en]gy4 ,! small p>ticles ( metal m>k+ ! c\rse ( ! missile %[ x 0 a %rapnel ball4 ,illu/ration3 ,plate #ach4 ,,%rapnel--,,plate #ach4 ,,l[] ,,extremity4 ,gun%ot ,fracture ( ! ,"r ,tibia & ,fibula4 ,?is plate %[s a type ( w\nd caus$ by a numb] ( fragm5ts ( a %rapnel ball or o!r simil> missile4 ,! missile 0 de=m$ by a ne>-by rico*et1 f :i* l>ge & small fragm5ts /ruck simultane\sly & di/ribut$ !mselves ov] a l>ge area4 ,! l>g] fragm5ts c>ri$ en\gh en]gy to fracture ! bone by transmitt+ all ( _! en]gy 9 lodgm5t & by possibly break+ up into small] fragm5ts4 ,9 ?is case ! en]gy ( ! missile 0 transmitt$ to ! tibia1 ) fracture & great fragm5tation ( ! bone4 ,! fracture ( ! tibia 0 second>y1 result+ f indirect viol5ce1 due to ! loss ( ! support ( ! tibia4 ,illu/ration3 ,plate #aci4 ,,%rapnel--,,plate #aci4 ,,l[] ,,extremity4 ,gun%ot ,fracture ( ! ,"r ,tibia & ,fibula4 ,! c\rse ( ! missile 0 f )9 outw>d & f be=e backw>d1 /rik+ bo? ! fibula & ! tibia1 ) fragm5tation & displacem5t ( bo? bones4 ,! fibula lay next to ! plate1 z indicat$ by its di/9ct normal %ad[ & ! exagg]at$ outl9e ( ! int]nal malleolus4 ,! trail ( metal fragm5ts is typical ( a %rapnel ball ) ! en]gy ( high %rapnel velocity1 b any lead missile )\t a protective jacket1 "u l conditions1 might h produc$ ! same effect4 ,! treatm5t is cons]vative until "s positive indication aris+ 9 ! c\rse ( an infection directs int]f]5ce4 ,illu/ration3 ,plate #adj4 ,,%rapnel--,,plate #adj4 ,,l[] ,,extremity4 ,gun%ot ,fracture ( ! ,left ,tibia & ,fibula1 ) ,lodgm5t ( ! ,missile4 ,z ! heel lay on ! plate x is easy to id5tity ! tibia & fibula ( ! left leg4 ,! c\rse ( ! ball f ! int]nal malleolus across to ! l[] end ( ! tibia & fibula is well m>k$ by ! trail ( metal p>ticles left by ! contact ( ! ball ) ! bones4 ,! indi/9ctness ( ! %ad[s ( ! lead p>ticles & ( ! ball & ! v slight enl>gem5t ( ! ball indicates a contact ) ! ant]ior surface ( ! tibia & ( ! fibula ) lodgm5t ( ! ball b5ea? ! sk9 at ! ant]ior bord] ( ! l[] end ( ! fibula4 ,! rema9+ en]gy ( ! missile 0 almo/ entirely sp5t on ! tibia1 caus+ a long oblique fracture1 s t ! contact ) ! fibula result$ 9 a crack only1 )\t ! sep>ation ( a fragm5t4 ,! treatm5t 9 su* cases is cons]vative1 ) ! subsequ5t removal ( ! ball f its sup]ficial location4 ,illu/ration3 ,plate #ada4 ,,%rapnel--,,plate #ada4 ,,l[] ,,extremity4 ,gun%ot ,fracture ( ! ,left ,tibia1 ) ,lodgm5t ( ! ,missile4 ,! c\rse ( ! ball 0 f )\t & beh9d1 rang+ upw>d & inw>d1 /rik+ ! tibia on ! out] bord]1 & caus+ a splitt+ fracture )\t displacem5t ( fragm5ts4 ,! missile 0 mo/ probably de=m$ by rico*et be=e x /ruck ! bone1 z !re is too little bone injury to acc\nt = ! spatt]+ & wide di/ribution ( ! fragm5ts by ! direct impact ( an unde=m$ ball4 ,two metallic fragm5ts ly+ ov] ! fibula 7 probably additional missiles deta*$ f ! ball z x rico*et$ ne> ! w\nd4 ,! treatm5t 9 su* cases w\ld be cons]vative1 :ile meet+ ! indications ( infection4 ,illu/ration3 ,plate #adb4 ,,%rapnel--,,plate #adb4 ,,l[] ,,extremity4 ,gun%ot ,fracture ( ! ,left ,fibula1 ) ,lodgm5t ( ! ,missile4 ,?is plate furni%es ano!r example ( ! fragm5tation ( a %rapnel ball by rico*et on a ne>-by object be=e /rik+ ! body4 ,a slight fracture ( ! fibula is se5 7at ! top ( ! plate7 ) ! lodgm5t ( multiple missiles ov] a wide area1 )\t o!r injury to ! bones4 ,! fragm5ts se5 ?r\gh ! %ad[ ( ! tibia lie ne>] ! plate ?an ! small] fragm5ts on ! fibula4 ,z ! l>ge/ fragm5t1 ly+ bel[1 %[s a mu* enl>g$ semicircul> outl9e1 its position is n close to ! plate & x mu/ lie sup]ficially on ! inn] side ( ! leg4 ,illu/ration3 ,plate #adc4 ,,%rapnel--,,plate #adc4 ,,l[] ,,extremity4 ,gun%ot ,fracture ( ! ,"r ,fibula4 ,?is plate %[s ! "r leg1 because ! calf always re/s on ! plate 9 ! abs5ce ( a contra9dication1 :i* does n occur 9 ?is case1 & because ! slight angle ( approa* ( ! tibia & fibula id5tifies ! relation ( ! l[] end ( ^! bones4 ,! nature ( ! fracture1 )\t mu* fragm5tation & ) no displacem5ts ( fragm5ts1 indicates a slight /rik+ en]gy ( ! missile1 :i* 0 dis9tegrat$ by rico*et be=e /rik+ ! bone4 ,! fragm5ts ( a %rapnel ball1 spatt]$ on a ne>-by object1 /ruck ! leg 9 front ov] a wide area1 z indicat$ by ! fragm5ts ly+ ov] ! tibia & small] ones ly+ on ! inside ( ! bone4 ,! l>g] metal fragm5t1 on ! fibula1 is "s di/ance f ! plate1 & probably lies 9 front ( ! bone1 :ile ! small] ones1 se5 9 %>p] outl9e1 lie beh9d4 ,illu/ration3 ,plate #add4 ,,%rapnel--,,plate #add4 ,,l[] ,,extremity4 ,gun%ot ,fracture ( ! ,left ,fibula4 ,?is is ano!r example ( ! condition1 %[n 9 plate #adc1 9 :i* a %rapnel hall or simil> missile is dis9tegrat$ by rico*et be=e a fleet+ ! w\nd4 ,by comp>ison ( ! %ad[s ( ! missiles ) ! %ad[s ( ! portion ( ! localiz+ wire ly+ ne>] ! plate 7%[n m deeply & di/9ctly71 & ) ! portion ly+ 9 front ( ! leg1 x c be conclud$ t ! fragm5ts lie sup]ficially 9 front ( ! bones4 ,a slight fissure fracture ( ! fibula may be se5 9 ! upp] portion ( ! plate4 ,illu/ration3 ,plate #ade4 ,,%rapnel--,,plate #ade4 ,,l[] ,,extremity4 ,gun%ot ,fracture ( ! ,fibula1 ) ,lodgm5t ( ! ,missile4 ,! fibul> side ( ! leg lay next to ! plate4 ,! %>p outl9e1 great d5sity1 & normal size ( ! %ad[ ( ! %rapnel ball %[s ! ball almo/ 9 contact ) ! plate4 ,! metallic p>ticles m>k+ ! contact ( ! ball & ! fibula1 at ! seat ( a diagonal fracture1 )\t displacem5t ( fragm5ts1 are %[n s di/9ctly t !y mu/ also be ne> ! plate4 ,! c\rse ( ! ball1 !re=e1 0 f )\t1 rang+ inw>d & upw>d ) ! slight en]gy ( long 7%rapnel7 range4 ,! ball lies on ! fibul> side sup]ficially1 j 9 front ( ! fibula4 ,illu/ration3 ,plate #adf4 ,,%rapnel--,,plate #adf4 ,,l[] ,,extremity4 ,gun%ot ,fracture ( ! ,"r ,fibula4 ,! plate expos$ ) ! tibial side d[n %[s ! w\nd 9 ! c\rse ( treatm5t1 ) a dra9age tube 9 position aft] ! deta*$ fragm5ts ( sev]al in*es ( ! fibula h be5 remov$ on acc\nt ( infection4 ,sev]al fragm5ts ( ! missile are %[n on ! l[] fragm5t ( ! fibula4 ,cons]vative treatm5t is evid5t & good results %\ld foll[4 ,illu/ration3 ,plate #adg4 ,,%rapnel--,,plate #adg4 ,,l[] ,,extremity4 ,gun%ot ,w\nd ( ! ,l[] ,end ( ! ,"r ,fibula4 ,z ! heel lay next to ! photographic plate1 ! "r ankle is easily id5tifi$4 ,! cle> %ad[s ( ev5 ! v small metallic p>ticles %[ !m also next to ! plate &1 !re=e1 on ! po/]ior surface ( ! ext]nal malleolus1 :]e a %rapnel ball at extremely l[ velocity /ruck & produc$ a slight fracture1 or m ( a fissure1 )\t sep>ation ( fragm5t4 ,! jo9t mortise is intact1 z ! l9e ( fracture does n ext5d to ! articul> surface4 ,! %rapnel ball 9 su* cases w\ld lie j b5ea? ! sk9 or escape ?r\gh an adjac5t w\nd4 ,illu/ration3 ,plate #adh4 ,,%rapnel--,,plate #adh4 ,,l[] ,,extremity4 ,gun%ot 7,pott's7 ,fracture ( ! ,left ,ankle4 ,z ! heel lies next to ! plate1 ! left ankle is easily id5tifi$4 ,! c\rse ( ! missile is %[n by a metallic track f ! int]nal to ! ext]nal malleolus1 & by a po9t ( great] contact ) ! int]nal malleolus at ! upp] bord] ( its articulation ) ! a/ragulus1 result+ 9 an oblique fracture1 sep>at+ ! tip ( ! ext]nal malleolus4 ,at ! po9t ( fir/ impact ! po/]ior faciculus ( ! int]nal lat]al ligam5t 0 sev]$4 ,! missile !re=e pass$ directly ?r\gh ! ankle jo9t1 ent]+ j beh9d ! tip ( ! ext]nal malleolus1 c\rs+ ov] ! po/]ior portion ( ! sup]ior tibial articulation ( ! a/ragalus 9 front ( ! t5do ,a*illis to /rike ! upp] articul> surface ( ! ext]nal malleolus1 ) ! result+ fracture4 ,by ?is me*anism1 ! jo9t mortise has be5 wid5$ by outw>d displacem5t ( ! ext]nal malleolus1 :ile ! rupture ( ! int]nal lat]al ligam5t p]mitt$ ! outw>d rotation ( ! a/ragulus1 ?us produc+ r fai?fully1 by direct viol5ce1 a condition :i* might be call$ a 8simulat$ ,pott's fracture0 ( ! fir/ degree4 ,by ! metallic pa? ( ! missile x is kn[n t its s(t metal mass 0 n protect$ by a h>d metal jacket2 by ! slight damage done to ! bone1 :i* lay directly 9 its pa?1 its velocity & consequ5t en]gy are reveal$ z v slight2 by ! abs5ce ( l>g] metallic fragm5ts x is %[n t ! missile 0 n de=m$ nor robb$ ( its en]gy ?r\gh rico*et2 & z only ^! conditions c be furni%$ by a lead ball1 unde=m$ & travel+ at l[ velocity1 ! missile 0 a %rapnel ball4 ,illu/ration3 ,plate #adi4 ,,%rapnel--,,plate #adi4 ,,l[] ,,extremity4 ,multiple ,gun%ot ,w\nd ( ! ,leg4 ,?is plate exhibits ! *>act]i/ic m>k+ ( ! metal p>ticles ( a %rapnel ball scrap$ (f by contact ) ! bone1 %[+ ! c\rse ( ! ball 9 relation to ! bone4 ,! evid5ce t two %rapnel balls /ruck ! tibia )\t caus+ a fracture indicates t ! velocity ( %rapnel balls is1 sometimes at lea/1 v l[ & t ?is l[ velocity may occur at a comp>atively %ort range f ! po9t :]e ! %rapnel balls are dis*>g$ f ! *amb] or ne> ! apex ( ! 8cone ( disp]sion40 ,su* multiple w\nds are caus$ be=e ! balls h be5 s widely disp]s$ z :5 !y arrive at ! base ( ! 8cone ( disp]sion40 ,illu/ration3 ,plate #aej4 ,,%rapnel--,,plate #aej4 ,,l[] ,,extremity4 ,gun%ot ,fracture ( ! ,left ,a/ragalus1 ) ,lodgm5t ( ! ,missile4 ,! ext]nal bord] ( ! foot lay next to ! plate1 z is %[n by ! articulation ( ! cuboid4 ,a fragm5t deta*$ f ! po/]ior inf]ior bord] ( ! a/ragalus & sev]al small metal p>ticles ly+ beh9d ! fragm5t are 9 evid5ce4 ,! enl>g$ %ad[ ( ! ball indicates t x does n lie close to ! plate1 & x mu/ !n lie at lea/ z f> away z ! int]nal surface ( ! calcaneus & at a dep? f ! sole t c be measur$ on ! plate4 ,illu/ration3 ,plate #aea4 ,,%rapnel--,,plate #aea4 ,,l[] ,,extremity4 ,gun%ot ,fracture ( ,left ,calcaneus4 ,! fibul> side lay next to ! plate1 z %[n by ! %ad[ ( ! fibula & ! calcaneo-cuboid articulation4 ,z ! metallic p>ticles1 %[+ ! pa? ( ! missile1 appe> to be next to ! plate1 ! c\rse ( ! missile 0 f ! ext]nal bord] ( ! t5do ,a*illis diagonally d[nw>d & =w>d1 caus+ only a slight fissure ( ! calcaneus4 ,a missile1 to h done s little damage & to h left a metallic track %[+ its contact ) ! bone1 mu/ h be5 unjacket$ & ( l[ velocity1 & !re=e a %rapnel ball4 ,illu/ration3 ,plate #aeb4 ,,%rapnel--,,plate #aeb4 ,,l[] ,,extremity4 ,gun%ot ,w\nd ( ! ,heel1 ) ,lodgm5t ( ! ,missile4 ,! tibial side ( ! foot lay next to ! photographic plate4 ,! normal size1 great d5sity1 & %>p outl9e ( ! %ad[ ( ! %rapnel ball %[ t x lay also close to ! plate & ab\t an in* bel[ ! inside ( ! body ( ! calcaneus4 ,no metallic p>ticles m>k ! track ( ! ball 9 ?is case1 because ! c\rse 0 p>allel to ! inn] surface ( ! bursa )\t =ceful1 or p]haps any1 contact ) ! bursa1 & pass+ ?r\gh s(t tissue1 only4 ,illu/ration3 ,plate #aec4 ,,%rapnel--,,plate #aec4 ,,l[] ,,extremity4 ,gun%ot ,w\nd ( ! ,heel1 ) ,lodgm5t ( ! ,missile4 ,t ! inn] bord] ( ! foot lay next to ! plate is %[n by ! articulation betwe5 a/ragalus1 scaphoid1 int]nal cunei=m1 & fir/ metat>sal4 ,! metallic p>ticles %[ ! c\rse ( ! ball f ! po/]ior calcaneo-a/ragaloid ligam5t to bel[ ! ant]ior inf]ior bord] ( ! calcaneus4 ,z ! %ad[ ( ! ball is enl>g$ & ! %ad[ ( ! fragm5ts blurr$1 _! position is n ne> ! plate & _! location is !re=e on ! ext]nal plane ( ! calcaneus1 ) ! ball ly+ ne> ! sole4 ,illu/ration3 ,plate #aed4 ,,%rapnel--,,plate #aed4 ,,l[] ,,extremity4 ,gun%ot ,w\nd ( ! ,foot4 ,! plate %[s1 9 ! w\nd ( entrance1 ! metal p>ticles deposit$ by a %rapnel ball :i* pass$ out ( ! sole ( ! foot )\t damage to ! bone4 ,! missile c>ri$ "s small p>ticles ( lead1 almo/ :olly deta*$ by a rico*et be=e /rik+ ! foot1 :i* 7 scrap$ (f z x pass$ ?r\gh ! sk94 ,! w\nd 0 infect$1 & radiography 0 indicat$ = diagnosis4 ,illu/ration3 ,plate #aee4 ,,%rapnel--,,plate #aee4 ,,l[] ,,extremity4 ,gun%ot ,w\nd ( ! ,foot4 ,! sole ( ! foot lay next to ! plate4 ,:ile ! v cle>1 %>p outl9es ( ! metal fragm5ts w\ld seem to %[ !m v ne> ! plate & consequ5tly at ! plat5 side ( ! t>sus1 ! foot is n ( suffici5t ?ickness to make a v appreciable diff]5ce betwe5 %ad[s ( su* fragm5ts on ! dorsal & on ! plant> surfaces ( ! metat>sus4 ,x is v probable t ! ball /ruck ! convex1 r ?an ! concave outl9e ( ! transv]se ar*1 z ! missile has escap$ ) no fracture ( ! bones1 :i* w\ld h be5 v difficult 9 me*anical accompli%m5t if its c\rse _h be5 along ! convex outl9e4 ,!re is no fracture ( ! bones1 al?\gh a %rapnel ball has pass$ transv]sely ?r\gh ! foot1 /rik+ ! heads ( ! second & ?ird metat>sals ) only slight injury & leav+ a few metal p>ticles at po9ts ( contact4 ,illu/ration3 ,plate #aef4 ,,%rapnel--,,plate #aef4 ,,l[] ,,extremity4 ,gun%ot ,w\nd ( ! ,left ,foot by ,multiple ,missiles1 ,fracture ( ! ,metat>sus1 & ,lodgm5t ( ! ,missile4 ,! sole ( ! foot lay next to ! plate4 ,! normal outl9e ( ! %ad[ ( ! %rapnel ball %[s x to lie ne> ! plate or at lea/ b5ea? ! plant> surface ( ! fir/ metat>sal4 ,! fragm5ts ( metal ly+ ne> ! f\r? & fif? metat>sals lie ei!r 9 ! same relation or on ! plant> side ( ! metat>sus4 ,! metallic track leads to ! w\nd ( exit ( %rapnel ball1 o!r ?an ! "o lodg$4 ,ev5 ?\gh ! missile has escap$1 its id5tity c be cr$itably e/abli%$ by ! "o rema9+1 :i*1 x is morally c]ta91 0 ! escap$ missile's companion4 ,^! %rapnel p>ticles aga9 demon/rate t ! metal deposits se5 9 o!r w\nds c be id5tifi$ z p>ticles ( lead scrap$ (f f %rapnel balls 9 ! contact ( ! latt] ) bones4 ,illu/ration3 ,plate #aeg4 ,,op]ative ,,int]f]5ce ,,9 ,,gun%ot ,,w\nds4 ,9 ! #a1ejj radiograph plates f :i* ?is collection 0 select$1 only f\r 7 f\nd %[+ op]ative int]f]5ce = ! repair ( fractures4 ,:ile no data are available f :i* to det]m9e accurately ! ratio ( ^! op]ations to ! entire numb] ( fracture cases "u treatm5t1 & z1 mo/ c]ta9ly1 !re 7 "s =mal amputations1 excisions1 imm$iate immobilization ( fractures1 & o!r op]ative proc$ures :i* 7 n submitt$ to radiography1 x may nev]!less be ju/ly inf]r$ f ?is radiographic evid5ce t v few su* op]ations 7 p]=m$4 ,,op]ations--,,plate #aeg4 ,gun%ot ,fracture ( ! ,hum]us4 ,?is plate %[s an attempt to wire a fracture ( ! hum]us1 :i*1 v probably1 w\ld h recov]$ z favorably )\t int]f]5ce4 ,illu/ration3 ,plate #aeh4 ,,op]ations--,,plate #aeh4 ,gun%ot ,fracture ( ! ,ulna4 ,?is plate %[s an attempt to wire ! ulna 9 a clean w\nd4 ,illu/ration3 ,plate #aei4 ,,op]ations--,,plate #aei4 ,gun%ot ,fracture ( ! ,radius & ,ulna4 ,?is plate %[s an attempt to wire ! radius & ulna :]e ! indications 7 r d\btful4 ,illu/ration3 ,plate #afj4 ,,op]ations--,,plate #afj4 ,gun%ot ,fracture ( ! ,tibia & ,fibula4 ,?is plate %[s an attempt at imm$iate immobilization ( ! fragm5ts ( ! tibia :i* has fail$ to meet ! me*anical indications = ma9ta9+ correct position4 ,illu/ration3 ,plate #afa4 ,,op]ations--,,plate #afa4 ,amputation at ! ,knee ,jo9t4 ,?is plate %[s a satisfactory result ( a second>y amputation at ! knee1 aft] ! me?od ( ,gritti1 foll[+ a sev]e naval %ell w\nd ( ! leg4 ,illu/ration3 ,plate #afb4 ,,op]ations--,,plate #afb4 ,excision ( ! ,head ( ! ,hum]us4 ,?is plate %[s a case ( ,pr(4 ,de ,page1 ( ! ,belgium ,r$ ,cross ,mission at ,ta% ,ki%la ,hospital1 9 :i* ! head ( ! hum]us 0 excis$ = ext5sive comm9ution ( ! head ( ! hum]us ) infection4 ,illu/ration3 ,plate #afc4 ,,"s ,,missiles ,,remov$ ,,f ,,w\nd$ ,,9 ,,balkan ,,w>s4 ,figures r$uc$ to two-?irds ( natural size4 ,,plate #afc4 ,( ! #df missiles %[n 9 ! illu/ration1 page #ccf1 #a to #ad are rifle bullets2 #ae to #bb are assort$ fragm5ts2 #bc to #dc & includ+ #dd are %rapnel balls2 #de is an automatic pi/ol ball1 & #dc & #df are ! base & ! fuse1 respectively1 ( a %rapnel 8nose0 or head ( ! #ge-millimet] field gun4 ,f\r rifle bullets1 ?ree %rapnel balls1 & ,nos4 #bj & #bg 7 remov$ f ,turki% soldi]s admitt$ to my s]vice at ,ta% ,ki%la ,hospital 9 ,con/ant9ople4 ,! rema9+ missiles1 except+ ,no4 #df1 7 remov$ f ,bulg>ian soldi]s on my s]vice at ! ,etap & ! ,que5's ,hospital at ,ku/5dil1 ,bulg>ia4 ,! missile %[n z ,no4 #df 0 remov$ by ,dr4 ,tat>*eff1 ! ,bulg>ian surgeon 9 comm& ( a fix$ hospital at ,kodemos1 ,bulg>ia1 f ! upp] ant]ior ?igh ( a pati5t ^: hi/ory ,i h & :om ,i saw & photograph$4 ,( ! fragm5ts1 ,nos4 #ae & #ag are pieces ( ! nickel jacket ( rifle bullets2 ,no4 #af is ! lead 8core0 ( a rifle bullet2 ,no4 #bb is a fragm5t ( ! nickel jacket ( a rifle bullet :i* holds a small portion ( ! lead core2 ,no4 #ah is a brass tube :i* is c>ri$ 9 ! base ( a %ell to hold ! detonat+ plung] & fulm9ate cap2 ,no4 #ai is a piece ( a foot plate or /ep ( a gun c>riage or caisson2 ,no4 #bj is a %ell fragm5t1 & ,no4 #ba is a flatt5$ piece ( a %rapnel ball4 ,( ! bullets1 ,no4 #a is ,bulg>ian1 remov$ f a ,bulg>ian soldi] 9 an op]ation = an abdom9al w\nd accid5tly inflict$ dur+ ! fir+ incid5t to ! celebration att5d+ ! ann\ncem5t ( peace2 ,nos4 #f1 #aj1 #aa1 & #ad are ( ! same calib] z ! ,bulg>ian & 7 fir$ f ,mont5egr9 or ,s]vian rifles2 ,nos4 #b & #c1 slightly small] 9 calib] ?an all ! o!rs1 are ,greek1 & ,nos4 #d1 #e1 #g1 #h1 #i1 #ab1 & #ac are ,s]vian1 slightly l>g] ?an ! ,greek & z mu* small] ?an ! ,bulg>ian4 ,no4 #a is abraid$ at ! base by ! jaws ( a =ceps by :i* x 0 remov$ f ! w+ ( ! ilium 9 :i* x 0 firmly emb$d$2 ,nos4 #d1 #g1 #h1 #ab1 #ac1 #ad are de=m$ by rico*et4 ,no4 #e has its nose slightly abraid$ by ! same cause4 ,no4 #h %[s ! lead core protrud+ f ! base ( ! jacket4 ,nos4 #a1 #b1 #c1 #f1 #i1 #aj1 & #aa are normal1 z !y /ruck ! body by direct impact4 ,nos4 #b & #c1 :i* are ,greek1 h ! nickel jacket worn (f on ! apex s t ! lead core is expos$1 :i* produces a slight degree ( 8dum-dum10 b z !y /ruck ! body at v long range & )\t hitt+ a bone1 !y produc$ no 8dum-dum0 effect4 ,eight ( ! %rapnel balls 7 remov$ f ! =e>m ( "o ,bulg>ian soldi]4 7,vide plate #aji47 ,no4 #dc 0 remov$ f betwe5 ! ?oracic wall & ! scapula1 to :i* position x pass$ by de/roy+ ! out] half ( ! clavicle1 p5etrat+ #f in*es f ! surface4 ,! calib] ( ! missiles4 ,millimet]s4 ,greek #f4ej ,s]vian #g4jj ,bulg>ian #h4jj ,mont5egr9 #g4je & #h4jj ,= comp>ison x may be obs]v$ t ! ,unit$ ,/ates ,army rifle bullet is #g millimet]s1 equal #cj calib] or #j4cj in*4 ,! calib] ( %rapnel balls v>ies some:at1 z d ! weight & d5sity1 b all ( !m 7 approximately in* or #abe millimet]s 9 diamet]4 ,! calib] ( all field guns 7( mod]n type7 9 ! ,balkan w>s 7 #ge millimet]s1 ! 8soixante-qu9ze0 ( ! ,fr5*1 or ab\t #c in*es4