UPPER EXTREMITY.
Gunshot Fracture of the Wrist.
Wound of entrance, posterior aspect of forearm over the lower end of the radius, with the bullet ranging forward and slightly downward to the wound of exit and covering with great laceration the anterior aspect of the wrist joint.
The range was close, and the energy of the high velocity of the missile was imparted to fragments, which, becoming “secondary missiles,” emerged with the projectile to cause extensive laceration and destruction of tissue.
The case was received for amputation in the second week, when a grave degree of infection extended in a cellulitis to the elbow. The ulnar nerve and vessels were intact, but the flexor tendons were almost entirely destroyed.
The plate, made after several weeks, when infection was under control and after the end of the radius and fragments of the carpus had been informally removed, shows a rarefaction of the carpus and proximal ends of the metacarpus, due to infection and disuse.
Frequent incisions and extension of drainage, with removal of detached fragments, was continued for several months. The wound was closed in the sixth month, with ankylosis and deformity of the wrist, as shown in [plate 42].
Plate 42.
Rifle—Plate 42.