adily seen to be probable.
Each bone offered some special features dependent on its structural
character and anatomical position. In the case of the _ulna_, pure
perforation of the olecranon process, without obvious evidence of
implication of the elbow, was seen on several occasions. The other
important feature with regard to this bone depends on its subcutaneous
position, which accounted for the frequency with which highly developed
explosive exit wounds were met with. One is figured in the general
section (fig. 47, p. 156). This, however, is a very slight instance
compared with what was often seen in the upper and middle thirds of the
bone, where the lateral soft parts often protruded as a much larger
tumour, the particular illustration being mainly designed to show the
nature of the injury to the skin. The _radius_, as more deeply placed in
the upper part of its course, was less often the seat of such
well-marked explosive injuries; but when the lower end was struck this
character was sometimes very striking: thus in a track passing
antero-posteriorly through this bone, the whole lower end appeared
shattered, all the tendons at the back of the wrist being implicated in
the protruding mass, while the bone itself seemed shortened, so that the
hand took up the position common in Colles's fracture. It was found
impossible to place the bone in good position; nevertheless the patient
retained his hand, which is still of use in writing.
Plate X. is a good example of a high-velocity injury in which lateral
contact with the radius has produced local comminution, some slight
injury to the casing of the bullet, and the separation of a large wedge.
The case from which this was taken also illustrated well one of the
chief troubles of such fractures of the forearm; the degree of
splintering resulted in the formation of a large mass of callus, which
for a time rendered any degree of pronation and supination impossible.
[Illustration: PLATE VI.
Skiagram by H. CATLING.
Engraved and Printed by Bale and Danielsson, Ltd.
(26) COMMINUTED FRACTURE OF THE HUMERUS
Range '250 yards.'
Impact oblique. Wound of entry 1 inch below the insertion of the
deltoid; exit, on inner aspect of arm at a slightly lower level. The
bullet probably struck the bone laterally, and drove out the central
fragment.
Prolonged suppuration resulted, but the humerus healed well, and good
movement of the elbow was preserved.
The effect of oblique
|