injuries to the femur in which the shaft was chipped or grooved
without loss of continuity were not uncommon, and showed well the
capacity of the bone to withstand the lateral shock transmitted by small
bullets. Two figures inserted in the chapter on wounds in general (figs.
22, 23, pp. 61, 62) are of cases in which, from the appearance of the
wound of exit, the bullet probably underwent deformation, or was so
deflected as to escape on a considerably altered axis. Beyond the nature
of the exit wound in the case depicted in fig. 22, some thickening
beneath the femoral vessels denoted bone injury, but unfortunately no
skiagram was taken.

I saw no case in which a transverse fracture of the shaft accompanied
such injuries, but am under the impression that, if they had been
produced by bullets of greater volume and weight, transverse solution of
continuity would have been more common. In point of fact, no case of
pure transverse fracture of the femur ever came under my notice.

The diagram depicted in fig. 51, p. 164, is from a sketch made of the
lower end of a femur in which a severely comminuted fracture followed by
suppuration necessitated an amputation of the thigh, performed by Major
Lougheed, R.A.M.C. It is inserted as an illustration of the tendency of
the fissures to stop short above the actual articular extremities of the
bones. In this case the comminution was extreme and accompanied by the
usual long lateral fragments, one of which measured five inches in
length and might well have extended into the knee-joint had that been an
ordinary occurrence.

Perforations of the lower extremity of the bone were very common. These
were sometimes transverse and limited to the articular extremity itself,
or the same limitation occurred to the antero-posterior tracks. These
were the slightest forms of injury, putting on one side incomplete
tunnels and grooves on the surface of the bone. With regard to the
latter, however, when they invaded the joint cavity the injury was
liable to be more severe than a complete perforation, in consequence of
the projection of comminuted fragments into the joint cavity near the
line of reflection of the synovial capsule and ulterior interference
with freedom of movement.

[Illustration: FIG. 55_a_.--Diagram of 'Butterfly' type.]

[Illustration: PLATE XIV.

Skiagram by H. CATLING.

Engraved and Printed by Bale and Danielsson Ltd.

(32) TYPICAL STELLATE (BUTTERFLY) COMMINUTED FRACTURE OF