Gunshot Wound of the Thigh, with Lodgment of the Missile.
The normal size, distinct outline, and considerable density of the shadow of the shrapnel ball show that it lies very near the plate, posterior to the bone and in the buttocks, quite superficially.
The treatment in such cases is always conservative. Pain or impairment of function indicate removal after convalescence.
Gunshot Fracture of the Femur, with Lodgment of the Missile.
The direct subtrochanteric impact disintegrated the missile and delivered all of its energy to the bone, with a resulting transverse fracture of the upper end of the shaft of the femur and longitudinal fragmentation of the shaft. The course of the shrapnel ball was from behind forward and from above downward, as is shown by the track of the metal fragments and the lodgment of a larger lead fragment on the shaft below the seat of fracture. The uppermost large lead fragment, as shown by the depth of its shadow, lies farther behind the bone and nearer to the photographic plate than do the other pieces of the ball, as indicated by their lighter shadows. All of the fragments seem to lie behind the bone.
The conservative treatment of this wound is justified by the attempt at repair, as indicated by the callus formation; but it is manifest, from the extremely faulty position, that the indication for immobilization and extension in strong abduction were not appreciated.
Proper management of conservative treatment in such cases gives good results.
Gunshot Fracture of the Femur, with Lodgment of Multiple Missiles.
The position of the femur is in outward rotation, as shown by the full shadow of the lesser trochanter and the vanishing of the greater trochanter behind the shoulder of the neck. The two larger missiles lie on the outer side of the bone and the others lie in front on the seat of fracture. The greatly deformed shrapnel balls and the slight chipping fracture of the femur indicate that the greater portion of the striking energy of the missiles was so dissipated in ricochet that but little force was left for attack on the bone.
The treatment in such cases is expectant and indication rarely arises for search for and removal of the missiles.
Gunshot Fracture of the Shaft of the Femur, with Lodgment of the Missile.