In these injuries, where the bone is much splintered, the detached portions, and any fragments which are only retained by very partial periosteal connections, should be removed; projecting spiculæ sawn or cut off;[11] the wound being extended at the most dependent opening where two exist, or fresh incisions being made for this purpose, if necessary; light water–dressing applied; the limb properly supported; and the case proceeded with as in cases of compound fracture from other causes. (See FRACTURE.) The same general rules also apply in preserving as much of the hand as possible, in gunshot injuries. If the shoulder or elbow joint be much injured, but the principal vessels have escaped, the articulating surfaces and broken portions should be excised. Care should be taken to see that the projectile has wholly passed out, or been removed. In a case of comminuted fracture of the humerus, in the 88th Regiment, no union having taken place a month after the injury, and some dead bone requiring removal, an incision was made for this purpose, when half the bullet was found between the fractured ends. Good union, with free motion of the arm, resulted, after this foreign body and the necrosed bone were taken away. The results of excision practiced in the shoulder and elbow joints, especially the former, after gunshot wounds, have been exceedingly satisfactory. Especial attention was directed to the practice of resections of joints after gunshot injuries in the Sleswick–Holstein campaigns between 1848 and 1851; and Dr. Friedrich Esmarch has published the results in a valuable essay on the subject. Of nineteen patients in whom the shoulder–joint was resected, in twelve a more or less useful arm was preserved; and seven died. Complete anchylosis did not occur in any one instance; and in several the power of motion became so great as to enable the men to perform heavy work. Of forty patients for whom resection of the elbow–joint was performed six died, thirty–two recovered with a more or less useful arm, one remained unhealed at the time Dr. Esmarch wrote, (1851,) and in one mortification ensued and amputation was performed. These operations present no peculiarities in the mode of performance or their after–treatment, as compared with similar resections in civil practice.