The treatment is conservative. The course in such cases, without infection, is very favorable, and not unfavorable even with infection. Results should be good. [Illustration: Plate 31.] RIFLE--PLATE 31. UPPER EXTREMITY. Gunshot Fracture of the Lower End of the Radius. Wound of entrance, anterior aspect of wrist, over internal border of radius. Wound of exit, posterior aspect of wrist between radius and ulna, with laceration. The range was described as “close”--within a hundred yards--with the bullet in high velocity. The energy of the projectile, imparted to small fragments of cancellous tissue, drove them through the wound of exit, and caused the laceration of the superficial tissues. The wound was infected (swelling of soft parts clearly shown): resolution followed extended treatment, with ankylosis of the wrist and radial displacement of the carpus. Emergency treatment in all such cases is antiseptic dressing without exploration or manipulation of fragments, and with splint immobilization. Results are unfavorable as to function, depending upon extent of destruction of tendons. [Illustration: Plate 32.] RIFLE--PLATE 32. UPPER EXTREMITY. Gunshot Fracture of the Ulna. The course of the bullet was transverse through the arm at the junction of the middle and upper thirds from behind the radial border externally to the ulnar border internally, striking the wall of the medullary canal with a punching effect that partly split off short longitudinal fragments and caused transverse and longitudinal cracks, without separation or displacement of fragments. The same ballistic conditions applied to cancellous tissue at the end of the bone would probably have bored through it without fracture. This effect is generally seen in wounds of small-caliber bullets traveling at reduced velocity of long range. The treatment is that of a simple fracture. Results, in such cases without infection, could not be bad. [Illustration: Plate 33.] 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.