Shrapnel—Plate 109.
UPPER EXTREMITY.
Multiple Gunshot Wounds of the Right Hand and Forearm,
with Fracture of the Metacarpus and Phalanges and
Lodgment of the Missile.
The hand lay with the palmar surface next to the plate. The distinct outline of the small metal fragments and the natural size of the shadow of the undeformed shrapnel ball show that they lay on the anterior side of the metacarpus. The arrangements of the metal particles and bone fragments and the indication of the point of entrance of one wound on the outer border of the metacarpal of the thumb indicate the course of the balls to have been from the radial to the ulna side of the palm. The undeformed ball, then, lies, most probably, in front of the second metacarpal. The deformed ball shows, in its enlarged shadow and not so distinct in outline as the normal ball, that it is on the dorsal surface of the third and fourth metacarpals.
The undeformed ball caused the fracture of the phalanx and metacarpal of the thumb; the deformed ball fractured the neck of the third metacarpal; a ball which escaped from the wound and touched the base of the first phalanx of the middle finger and fractured the first phalanx of the little finger; and another ball, which glanced along the anterior surface of the lower end of the shaft of the radius and left a deposit of metal to mark its course, also escaped from the ulnar border of the forearm at a point indicated in the plate.
Four balls were concerned with this wound; two of them have lodged with some damage and two others have escaped, after inflicting a slight injury. Multiple shrapnel wounds are common. It may be said that the greater the number of balls lodged in a given area the less the distance of the plane from the apex of the cone of dispersion of a shrapnel discharge.
Several shrapnel balls, lodged in a small area without causing much damage or exhibiting much power of penetration, indicate low velocity at close range of shrapnel balls on discharge from the shrapnel envelope.
In a personal case, eight shrapnel balls were removed from a forearm.