ust
be added as to the occurrence of the most characteristic of its
complications, musculo-spiral paralysis. This was frequent in every
position of the fracture, and came on either immediately, or, at a
subsequent period, as a result of callus irritation or pressure. Its
frequency is only what would be expected when the nature of the fracture
is considered, but the chief interest of the condition lay in the
difficulty of certainly detecting it in the initial stages of the cases;
this depended on the fact that in many of them the local shock to the
limb was so severe that the function of the whole of the muscles was
lowered, or in some cases, although the musculo-spiral was the nerve
chiefly affected, the other large trunks had also suffered concussion or
contusion. In consequence of this difficulty the actual localised
paralysis often only became evident at the end of a week, or even more,
when there was difficulty in deciding as to whether the paralysis was
primary or due to secondary trouble. In the fracture illustrated by
skiagram, plate IV., the nerve suffered complete division, and was
united some three months later, improvement in the symptoms being very
slow. The latter was a common experience, and although not unusual in
civil practice, I think it is more marked in these injuries as a result
of the more widespread character of the nerve lesion.

[Illustration: PLATE V.

Skiagram by H. CATLING.

Engraved and Printed by Bale and Danielsson, Ltd.

(25) COMMINUTED FRACTURE OF THE HUMERUS

Range '50 yards.' Velocity extreme.

Impact somewhat oblique. The bullet entered anteriorly about 3 inches
above the elbow crease. The wound of exit was on the inner aspect of the
arm and explosive in character; it still measured 4 inches by 2 inches
three weeks after the injury was received.

The wounds suppurated locally, but at the end of six weeks fair union of
the bone had taken place and the wound of exit had contracted to a
sinus. The musculo-spiral nerve was concussed, but not divided.

The skiagram was taken three weeks after the reception of the injury.

Comparison with plate IV. demonstrates the effect of high velocity in
free comminution of the bone, the sharper radiation of the stellate
lines of fracture, and the propulsion of bone fragments.]

The _bones of the forearm_ were also often fractured. The principal
peculiarity of these fractures was the common localisation of the injury
to one bone, which is re