Fragmentation of the mantle of the bullet has occurred. It will be noted that the fragments are lodged in both the proximal and distal segments of the track. This may indicate that the bullet was damaged prior to entry, or the recoil of fragments. I incline to the latter view. The skiagram was taken a fortnight after the injury.
The large median fragment carried forwards, and the small degree of comminution, suggest the decrease of resistance and prolongation of impact by carriage back of the arm when struck.
The fracture is one of the nearest approaches to a transverse cleft that I met with.
The plate may well be compared with No. XII., where the effect of increased resistance in augmenting the degree of comminution is seen.
Lesser degrees of the same kind of injury amounting to grooving of the surface or notching of the crest of the ilium were not uncommon, and the occasional large character of exit openings in buttock wounds pointed to contact of travelling bullets with other parts of the external pelvic wall.
Fig. 55.
Clean Gutter Fracture of the Ilium (range placed by patient at 300 yards. Highland Brigade, Magersfontein). The gutter was clean cut, and admitted the forefinger. The inner and outer tables of the bone were in part blown out of a large irregularly circular exit opening about 1½ in. above the crest of the ilium. The cancellous tissue was probably entirely blown out. Plates of the outer and inner tables still remained connected by their periosteum to the deep aspects of the iliacus and gluteus medius muscles. The peritoneal cavity was not opened. The patient did well. Compare with the gutter fractures of the skull shown in figs. 64, 66
Certain portions of the pelvis were subject to more severe comminution; thus in one case in which the bladder was wounded, a very much comminuted fracture of the horizontal ramus of the pubes was produced by a bullet which subsequently lodged in the thigh behind the femoral vessels. In this case the track was so oblique as to have necessitated almost pure lateral impact on the part of the bullet; hence the form of injury was nearly allied to the comminutions of the ilium already described.
