The course of the bullet at short range was transverse through the upper forearm, striking the radius in the center of the shaft and the ulna nearer the border. Several small fragments followed the course of the bullet, but did not emerge with it at the wound of exit to cause a laceration.
The capitellum was next to the photographic plate and the angular line of the radius can be seen crossing the straighter line of the ulna.
Further information is obtained from the examination of another view, plate 23, made of the same subject.
This plate was made from the wound shown in plate 22, with the arm in greater inward rotation. This position shows the wide separation of the large fragments of the radius.
Emergency treatment in such cases is antiseptic dressing only, without exploration, and with fixation by splints for transportation. The degree of infection determines the subsequent course of conservative treatment, with operative methods for correction of deformity reserved for further stage of convalescence and for best surgical facilities.
Gunshot Fracture of the Radius and Ulna in the Upper Third of the Forearm.
The course of the projectile was from within, outward and diagonally forward, with a direct impact on the ulna, and a tangential impact on the radius, with several lines of splitting fracture in the latter without detaching fragments. Particles of metal, spattered around the point of first impact, were deposited by the lead core of a bullet, exposed by a torn jacket, which struck the second bone with its jacketed surface.
The treatment is always conservative--meeting indications in case of infection.
Results are good for saving the limb, but not for avoiding deformity.
Wound of entrance, posterior surface of forearm over radius above the middle.
Wound of exit, below and in front of wound of entrance.
The course of the ball in mid range was from behind, forward, and slightly downward.
While the images of both bones of the forearm are superimposed, because they both lay in the plane of the projection of the shadow, it is probable that the radius lay nearer the photographic plate, because the head of the radius is shown in clearer outline. The fragments of the fracture can be seen as related to the outlines of the radius.