lesion. When the track was entirely
limited to the articular ends the small amount of damage at either
aperture was shown by clinical evidence in the rarity of subsequent
limitation of joint movements due to bony deformity.

[Illustration: FIG. 52.--Oblique perforation, implicating both epiphysis
and diaphysis. Large fragment detached at exit aperture. Caused by a
bullet travelling at a low rate of velocity. Compare with figs. 71 and
72 of a skull fracture. The dotted lines indicate the course of the
track]

Again, it was rare for fissuring to extend from these tunnels to the
articular surfaces; thus many instances could be given of perforation of
the head of the humerus, the olecranon, or the femoral condyles, in
which no evidence of joint fissure was discoverable. The slight amount
of resistance offered by the cancellous ends was also clinically
illustrated by the absence of severe synovial effusions when they were
struck. When the joint cavity was not crossed, slight effusion only
resulted, while in the case of fractures of the femoral shaft great
effusion into the knee-joint, resulting from the forcible vibration
transmitted to the limb, was a common feature, even when the point
fractured was situated above the centre of the bone. Again, when the
joint cavity was crossed a moderate degree only of haemarthrosis was the
most common result.

With regard to the implication of joints, either primary or secondary,
in connection with fractures of the articular ends, I am inclined to
place the lesions of the upper end of the tibia in a more important
position than those of any other bone. Evidence of this implication was
in my experience more frequent here than in any other situation. This
may in part be attributable to the complexity of structure of this
epiphysis, and perhaps more correctly to the influence of its irregular
outline in favouring lateral forms of impact on the part of the bullet
and consequent increase in the area of damage.

Next to tunnelling, grooving was the most common form of injury to the
short bones. In the case of superficial tracks the compact tissue might
be considerably comminuted, but not, as a rule, over a width greatly
exceeding the calibre of the bullet.

Comminution and crushing of a single or several bones were rare in
proportion to the occurrence of similar injuries produced by
Martini-Henry or large leaden bullets. When the condition was produced
by bullets of small calibre, I bel