covery.

[Illustration: PLATE XI.

Skiagram by H. CATLING.

Engraved and Printed by Bale and Danielsson, Ltd.

(30) COMMINUTED FRACTURE OF THE SECOND METACARPAL BONE

Large fragments of the mantle of the bullet.

Fragmentation of the bullet was comparatively common when the metacarpal
bones were struck, also free comminution of a somewhat coarser variety
than that seen when bones offering greater resistance were struck.

This may be a result of the more frequent lateral impact of the bullet
on these small bones.]

In spite of a considerable experience, I never saw a case of perforation
of either the head or neck of the thigh bone. I saw numerous tracks
emerging at the side of the femoral vessels and entering at the buttock
or vice versa, but never one accompanied either by effusion into the
hip-joint or impairment of movement. Considering the regularity with
which haemarthrosis occurred when the other joints were crossed, and also
the nature of the compact tissue of the neck of the femur, which must
have ensured some splintering, I do not think I can have overlooked an
injury of this nature. No doubt also the escape of the neck of the bone
was explained in some of the cases by the fact that the injuries were
received while the hip-joint was in a position of flexion, the bullet
passing over the neck of the femur. In two cases of extensive
comminution of the upper third of the femur that I saw, the fissures
stopped short at the inter-trochanteric line anteriorly, but in one of
them a large angular fragment was torn out of the posterior surface of
the neck.

Excepting transverse fracture every form was met with in the shaft,
although I saw only two instances of perforation. One has been already
alluded to and was situated in the broadening portion of the lower
third, the bullet taking an antero-posterior course. The second is seen
in plate XVII.

Plate XII. shows an instance of extreme comminution of the upper third
accompanied by the presence of two typical elongated fragments. The
course taken by the bullet was almost directly antero-posterior, and the
wounds were of moderate size even in the case of the exit one. This
seems to preclude the possibility of the injury having been produced by
a ricochet bullet, while the fact of perforation and escape of the
bullet in spite of the serious damage suffered by the mantle points to
the injury having been produced at a short range of fire. The patient
himself owns t