Frequent incisions and extension of drainage, with removal of detached fragments, was continued for several months. The wound was closed in the sixth month, with ankylosis and deformity of the wrist, as shown in plate 42.
This plate, presenting a lateral view of the wound shown in plate 41, shows considerable deformity of the joint, after four months’ treatment, which was even more marked two months later, when the case was discharged with an ankylosis of the wrist joint, contracture of the flexor tendons of the fingers, and slight flexor function of the thumb, permitting apposition with the first finger.
The result, while leaving much to be desired, preserved a function of the hand vastly superior to that of a forearm stump.
The treatment in such cases is always courageously conservative, with amputation only as the extreme measure to save life, with risks of judgment in favor of conservatism.
Corrective measures may be employed after management if the treatment of the infection is successful and when the case passes out of the military category. It is not possible, during a long infection, to maintain better position in such cases.
Wound of entrance, inner aspect of the hand over proximal end of the fifth metacarpal.
Wound of exit, on the outer border of the hand over the distal end of the second metacarpal.
The velocity of the bullet was in mid or long range, as it displaced no fragments, and as it made a point of entrance and exit about the same in appearance.
The wound was infected, which is more frequently the case in the hand than in the forearm.
The treatment is conservative with free incision and drainage in the management of infection.
The course of the bullet was anteroposterior through the base of the proximal phalanx of the middle finger, with a velocity of long range. It practically punctured the bones and split off a few fragments without displacement.
The wound of entrance would be much the same as the wound of exit, with the latter, but a little larger.
Penetrating Gunshot Wound of the Chest, with Lodgment of the Projectile Near Posterior Chest Wall.
Point of entrance, pectoral border and fourth rib.
The distinct shadow of the angle of the ribs shows that the posterior chest wall was next to the photographic plate, and that the larger and less distinct outline of the anterior portions of the upper ribs was farther from the plate.