Pistol-shot wounds of joints and soft parts are seldom of serious import apart from the risk of hæmorrhage and of infection.
Treatment.—The treatment of wounds of the soft parts consists in purifying the wounds of entrance and exit and the surrounding skin, and in providing for drainage if this is indicated.
There being no urgency for the removal of the bullet, time should be taken to have it localised by the X-rays, preferably by stereoscopic plates. In some cases it is not necessary to remove the bullet.
Wounds by Sporting Guns.—In the common sporting or scatter gun, with which accidents so commonly occur during the shooting season, the charge of small shot or pellets leave the muzzle of the gun as a solid mass which makes a single ragged wound having much the appearance of that caused by a single bullet. At a distance of from four to five feet from the muzzle the pellets begin to disperse so that there are separate punctures around the main central wound. As the range increases, these outlying punctures make a wider and wider pattern, until at a distance of from eighteen to twenty feet from the muzzle, the scattering is complete, there is no longer any central wound, and each individual pellet makes its own puncture. From these elementary data, it is usually possible, from the features of the wound, to arrive at an approximately accurate conclusion regarding the range at which the gun was discharged, and this may have an important bearing on the question of accident, suicide, or murder.
As regards the effects on the tissues at close range, that is, within a few feet, there is widespread laceration and disruption; if a bone is struck it is shattered, and portions of bone may be displaced or even driven out through the exit wound.
When the charge impinges over one of the large cavities of the body, the shot may scatter widely through the contained viscera, and there is often no exit wound. In the thorax, for example, if a rib is struck, the charge and possibly fragments of bone, will penetrate the pleura, and be dispersed throughout the lung; in the head, the skull may be shattered and the brain torn up; and in the abdomen, the hollow viscera may be perforated in many places and the solid organs lacerated.
On covered parts the clothing, by deflecting the shot, influences the size and shape of the wound; the entrance wound is increased in size and more ragged, and portions of the clothes may be driven into the tissues.
Fig. 62.—Radiogram showing Pellets embedded in Arm.