The ball struck the third knuckle and lodged beneath the skin between the fourth and fifth metacarpals, fracturing both bones without displacement of fragments. In the recent wound the condition would be apparent, but after days of inflammatory reaction and infection, the swelling is too great to make any determination by palpation.
The treatment is removal of the missile. Good results regularly follow.
Plate 107.
Shrapnel—Plate 107.
UPPER EXTREMITY.
Gunshot Fracture of the Left Metacarpus,
with Lodgment of the Missile.
The hand lies with its ulnar side next to the plate, as is indicated by the sharp outline of the swollen hypothenar eminence, nearer the plate than the thumb, with the enlarged, poorly defined, and rarefied shadow of its metacarpal and phalanges.
As the normal size of the balls and the clear outline of the metal fragments must place them almost in contact with the plate, the ball is located near the fifth metacarpal. As this is the same case as is shown in [plate 106], the conclusions drawn from each plate are confirmed by the other.
The wound is infected, as indicated by the swelling of the palm.