Rifle—Plate 33.
UPPER EXTREMITY.
Gunshot Fracture of the Left Ulna.
The course of the missile was from within outward, ranging downward to the wrist, by deflection, after striking the ulna in its upper half. The considerable striking energy retained in a small portion of the mass—consisting of only the nose and a little more of the jacket of the bullet, but sufficient to fragment a large section of the bone, and then to traverse more than half the length of the forearm—leaves no doubt that the shot was fired at very close range, and that the bullet was broken on a nearly resisting surface, leaving in the nose of the bullet a striking force equal to that of the entire projectile at long range.
The posterior surface of the forearm is next to the plate, as the distinct outline of the styloid process of the ulna and the posterior border of the articular surface of the radius shows. The radius and ulna are parallel in the most natural position of supination. The normal diameter and sharp outline of the nose of the bullet show it to be next to the plate and on the posterior surface between radius and ulna.
Fragments of the exposed lead core of the bullet have scraped off on the line of fracture in a manner peculiar to shrapnel wounds, but never seen in bullet wounds in which the jacket covers all of the lead core.
The treatment is regularly conservative and without interference, as in this particular wound, which was aseptic.
Secondary treatment may indicate correction of bone deformity.
Plate 34.
