Rifle—Plate 18.
UPPER EXTREMITY.
Gunshot Fracture of the Elbow,
without Injury to the Great Vessels and Nerves.
Wound of entrance, posterior to the external condyle.
Wound of exit, large laceration in front and above the internal condyle.
The wound is an example of the misnamed “explosive” action of a rifle bullet. The force and direction of the missile, in high velocity, split the bone into many fragments, and, transmitting its energy to some of the fragments, carried them through the skin and caused the large laceration at the point of exit by the simultaneous escape of the bullet and fragments. The wound was so heavily infected, that a cellulitis advanced to the shoulder and to the wrist to such extent that the arm was marked by eminent surgical opinion for amputation. Free incision, drainage, antisepsis and incidental removal of detached fragments controlled the infection and brought about slow resolution. After six months of careful treatment the wound was healed with an ankylosed elbow with normal function of the forearm, except for limited rotation.
Treatment indicated in such cases is always conservative. Infections contraindicate any formal surgical interference. The dangers of infection in such cases are to be risked to avoid amputation.
Results may be considered favorable even with elbow ankylosis.
Plate 19.
