Gunshot Roentgenograms A Collection of Roentgenograms Taken in Constantinople During the Turko-Balkan War, 1912-1913, Illustrating Some Gunshot Wounds in the Turkish — Context and Discussion

maller and the overlapping of larger fragments caused some shortening.

Treatment, expectant.

Gunshot Fracture of the Right Humerus, with Lodgment of the Missile.

Wound of entrance, antero-external aspect of upper third of arm.

The missile, deformed by ricochet, struck the bone with greatly reduced velocity and without sufficient energy to perforate the bone by which it was deflected slightly from its course and lodged in the arm.

This is something of the same effect that might have been caused by a shrapnel ball, under the same ballistic conditions with a normal shrapnel velocity giving about the same penetrating force.

The wound, without infection, is in the first week or two of repair, before any callus has formed.

Treatment is expectant.

Gunshot Fracture of the Left Humerus, with Lodgment of the Missile.

Wound of entrance, anterior surface of upper third of the arm.

The shadow of the missile shows by its distinct outline and normal diameter at the tip that the missile lies on the side near the plate; the shortened length of the projectile indicates that the long axis lay in an acute angle with a perpendicular to the plate.

The irregular outline of the base of the shadow and the fact of lodgment shows that the missile was deformed and that it was incidentally retarded in velocity by ricochet, so that its penetrating force was not sufficient to carry it through the arm.

The fragments of bone are large and the wound is of the same character as might have resulted from a shrapnel ball, for the normal ballistic conditions of the latter simulate the conditions that produced the wound.

The drainage tubes seen in the plate indicate infection.

The conventional treatment in such cases is drainage and other management of the infection without formal search for the projectile.

Results should be favorable.

Gunshot Fracture of the Humerus.

Wound of entrance, anterior internal aspect of middle and upper third of arm.

Wound of exit, opposite.

The missile has struck the side of the bone and pursued a course through the shaft, so that a transverse fracture, as well as the separation of several medium-sized fragments, resulted from the splitting effect of the missile.

A larger missile, i. e., a shrapnel ball, with the same striking energy could have been stopped by the bone, but a wider distribution of the same energy carried by a larger cross section would have produced larger fragments.

In this case the location of the shrapnel ball would furnish unquestioned evidence; or, if a shrapnel ball had produced this particular bone destruction, its path among the fragments would have been marked by traces of lead. Two metal fragments indicate that the lead core of the bullet was exposed.

The wound, not infected, was treated expectantly.

Result in such cases is favorable.

Gunshot Fracture of the Humerus.

The course of the missile was anteroposterior through the middle of the arm.

The ballistic conditions and lines of force applied to the bone were somewhat, if not entirely, similar to those producing the fracture shown in plate 11. The missile struck the wall of the shaft without passing through the medullary canal, but a secondary fragmentation of the two large fragments did not follow except for the breaking of the tip of the distal fragment.

There was little deformity and no infection.

Plaster dressing was applied and the slight outline of callus formation indicates the process of repair. The lack of contrast in the shadow of the bone is due to the opacity of the plaster dressing through which the Roentgen exposure was made.

Treatment in such cases is expectant.

Results should be uniformly good.

Gunshot Fracture of the Right Humerus, with Lodgment of the Missile.

Wound of entrance, about middle of the anteriorinternal aspect of the arm.

The course of the missile was from without, downward and inward to a point of lodgment above the internal condyle. The distinct outline and normal size of the base of the bullet shows it to be near the plate, with the internal condyle next to the plate in the exposure.

The bullet mushroomed when it struck the bone with a “soft nose,” in which the lead was not protected by a tough metal jacket. It may have been dum-dummed; it is remotely possible that the nose of the jacket was split by ricochet, or it is more probable that it was of the unjacketed variety.

The effect is identical with that of a shrapnel ball, striking with its normal low velocity, which is about the same as that of the missile in this wound.

The invariable characteristic of a shrapnel wound of a bone, namely, the small particles of metal marking its course in contact with the bone, is seen in this plate.