o being quite unable to give any estimate of the distance.
Although no suppuration occurred, this fracture was very slow in
consolidating, and the free comminution with consequent inaccurate
apposition led to the development of four inches shortening of the limb.
The skiagram was taken about six weeks after the occurrence of the
injury, a few days after I first saw the patient; I have, however, had
the opportunity of seeing a second skiagram taken some four months
later. This is of considerable interest, as throwing light on the mode
of union of such fractures. The two elongated fragments in the later
skiagram are widened to three times their original breadth, and form
buttresses on either side of the point of union, while the irregular
ends of the shaft are rounded off, and the mass of fine fragments behind
is consolidated. Beyond this the second skiagram shows that the upper
fragment, apparently intact in the first, was really split
longitudinally, and therefore was far less useful as a point of support
than might have been assumed from the earlier skiagram, plate XIII. The
case illustrates well the chief difficulty in the treatment of such
fractures: that of maintaining the fragments in line, since absolutely
no help is received from the apposition of the two ends, and artificial
traction alone must be relied upon.

[Illustration: PLATE XII.

Skiagram by H. CATLING.

Engraved and Printed by Bale and Danielsson, Ltd.

(31) HIGHLY COMMINUTED FRACTURE OF THE UPPER THIRD OF THE SHAFT OF THE
FEMUR

Range 'short.'

Impact fairly direct. The wounds were of moderate size and at nearly the
same level. The exit wound near the buttock fold was of moderate size,
and presented no special features.

Considerable fragmentation of the bullet occurred. The comminution of
the bone is very fine, suggesting high velocity, and great resistance by
the bone. The skiagram was taken five weeks after the injury was
received, and at that time no union had occurred.

Reference to plate XIII. will explain more fully the difficulty
experienced in maintaining this fracture in position. The upper fragment
is seen to be split into fragments, beyond the separation of the long
splinter on the inner side; hence no aid was to be obtained from the
apposition of the ends. About 2 inches of the shaft were actually
pulverised; the fine fragments seen in a mass to the inner side of the
bone in the exit portion of the back, eventually formed a large