The course of the missile was from the outer border of the hypothnear eminence diagonally downward through the palm, lodging against the second metacarpal bone with fracture of last four metacarpals.
The metal particles are not seen on the fourth and fifth metacarpals because the violence at these points was transmitted through soft parts, but the projectile spent its remaining energy directly against the second and third metacarpals.
The palm of the hand was next to the photographic plate, as indicated by the immediate contact of the thumb. The shadow of the bones is not dense, but in deep contrast with the shadows of the ball and metal fragments, which are so clearly outlined with the ball of normal size that the ball is thus shown to lie on the palmar side of the hand.
The treatment is conservative, with judicious interference when opportunity shall offer for removal of the missile.
Plate 106.
Shrapnel—Plate 106.
UPPER EXTREMITY.
Gunshot Fracture of the Left Metacarpus,
with Lodgment of the Missile.
The palm of the hand lies next to the plate. The ball is very slightly enlarged and the small metal fragments are indistinct, indicating that they and the ball lie on the back of the hand.