I never saw a case of stellate fracture, and by this my experience in
the case of the ilium was confirmed.

On two occasions I saw pure transverse fractures of the bone; in each
the wound was produced by a Lee-Metford bullet. This is of some interest
as denoting that the greater volume and weight, in conjunction with the
blunter tip, of the Lee-Metford may produce more severe injury to the
bones than the Mauser. I believe this to be the case, given an equal
degree of velocity on the part of the bullet at the moment of impact;
but it is probable that the position of the patella with regard to the
condyles of the femur when struck is of far greater importance in
relation to the production of transverse fractures. The skiagram
represented in plate XVIII. shows an obliquely transverse fracture,
which in this instance resulted from a crossing bullet, which grooved
the surface of the bone.

With regard to the two cases of transverse fracture above referred to, I
may add that one occurred in a youth under twenty, and a good result was
obtained by treatment with splints, and later by massage. In the second
the patient was a man over fifty, who had received other injuries. The
wound over the patella healed and some union had occurred, when the
patient fell and burst both the bone union and the skin cicatrix.
Secondary suppuration of the knee-joint, necessitating an amputation of
the thigh, followed, but the patient made a good recovery. The third
case also did well.

[Illustration: PLATE XXII.

Skiagram by H. CATLING. Engraved and Printed by Bale and Danielsson,
Ltd.

(40) NOTCH FRACTURE OF THE CREST OF THE TIBIA

Range 'short.'

The raising of the margins of the notch suggests a perforation. Compare
with figs. 51 and 57 in the text.]

The treatment of these injuries differed in no way from that adopted in
civil practice, given satisfactory surroundings. Suture might be
indicated in some cases of transverse fracture, but this would only be
necessary if the fragments were widely separated. The punctured
fractures needed treatment as for simple wounds, combined with a short
period of rest and pressure for the condition of haemarthrosis. It was
important not to prolong the period of rest beyond a week or ten days if
the effusion was slight, in view of possible ulterior interference with
range of movement in the knee-joint.

_Fractures of the tibia._--Some remarks have already been made regarding
fractures of the head