The course of the bullet was in an anteroposterior direction at a high velocity of short range, which, imparting its energy to the fragments, drove some of them through the tissues as “secondary missiles” and caused a laceration of the wound to exist. The longitudinal fragmentation and splitting indicates a considerable energy of the projectile, which may have been deflected, as its long axis was turned somewhat from the trajectory at the time of impact. The emergency treatment is antiseptic dressing and splint immobilization. The subsequent treatment is conservative with the removal of detached fragments and with control of infection as the course indicates. [Illustration: Plate 38.] RIFLE--PLATE 38. UPPER EXTREMITY. Gunshot Fracture of the Left Ulna. The course of the bullet was transverse through the middle of the forearm, striking the posterior border of the ulna. Small fragments were broken from the posterior wall of the medullary canal, without destroying the longitudinal continuity of the anterior wall. The velocity of the bullet was probably that of mid-range, as the striking energy of the impact was fairly great. The posterior surface of the forearm lay next to the plate. The emergency treatment is antiseptic dressing and splint immobilization. The subsequent treatment is that of a simple fracture, as infection is not usual. [Illustration: Plate 39.] RIFLE--PLATE 39. UPPER EXTREMITY. Gunshot Fracture of the Left Ulna. The course of the bullet, with the velocity of long range, was anteroposterior through the lower third of the forearm, striking the outer side of the bone. The initial velocity of the projectile was much reduced, as is shown by the tendency to puncture the bone without much fragmentation. There was no displacement of fragments as a direct result of the impact, although muscular contraction has caused some slight subsequent overriding. The wounds of entrance and exit were about the same, if not quite similar in appearance. The emergency treatment is the conventional antiseptic dressing with splint immobilization. The subsequent treatment is usually that of a simple fracture, as infection in such cases is rare. [Illustration: Plate 40.] RIFLE--PLATE 40. UPPER EXTREMITY. Gunshot Fracture of the Ulna. The course of the bullet was obliquely anteroposterior through the lower third of the forearm, striking the radial edge of the bone with a velocity of long range. The wounds shown in plates 35 and 39 represent conditions similar to those causing this wound, except that the ranges were progressively greater. In this case the projectile exhibited a punching effect at the point of impact, and although the lines of force are shown in characteristically divergent fissures, the energy imparted to the fragments--less than in the preceding cases--has not been sufficient to separate or to displace the fragments.