Gunshot Wound of the Shoulder, with Lodgment of the Missile. The course of the missile was transverse from the posterior surface of the greater tuberosity of the humerus to the internal border of the scapula, distributing small metallic fragments along its path. There is no injury to the bone. The remnant of the ball has passed behind the scapula and lies near its superior angle. The treatment in such cases is, of course, conservative, with no serious consequences expected from infection. [Illustration: Plate 83.] SHRAPNEL--PLATE 83. UPPER EXTREMITY. Gunshot Wound of the Shoulder, with Lodgment of the Missile. The course of the ball was transverse through the posterior border of the deltoid muscle without contact with the bone, which would have been revealed by small particles of lead scraped off from the ball. The actual size, normal outline, and great density of the shadow of the ball show that it lay next to the plate and that it is, therefore, lodged posterior and mesial to the glenoid portion of the scapula. The treatment is noninterference unless removal be indicated by pain, impairment of function, or infection. The results should always be good. [Illustration: Plate 84.] SHRAPNEL--PLATE 84. UPPER EXTREMITY. Gunshot Wound of the Shoulder, with Lodgment of the Missile. The course of the bullet was from before backward and upward through the deltoid to the anterior surface of the head of the humerus. The missile is not the conventional shrapnel ball, which is spherical and about one-half inch in diameter, for the shadow shows a larger axis in one direction with parallel sides, too symmetrical to be attributed to deformation. The ballistic conditions are those of shrapnel. The missile struck the bone an inch or two below the point of lodgment. Its path is shown by particles of metal. Pain or interference with function would be cause for interference in subsequent treatment, which otherwise would be expectant. [Illustration: Plate 85.] SHRAPNEL--PLATE 85. UPPER EXTREMITY. Gunshot Wound of the Shoulder, with Lodgment of the Missile. The missile lies behind the head of the humerus, under conditions similar to the cases shown in plates 83 and 84. The position of the hall is indicated by the outline and depth of shadow of the normal size of a shrapnel ball. The ball must therefore be very near the plate and behind the head of the humerus. There is no injury to the bone. The slight deformity of the ball was caused by ricochet before it caused the wound, as no particles of lead are seen on the bone to account for the impact of the missile. [Illustration: Plate 86.] SHRAPNEL--PLATE 86. UPPER EXTREMITY. Gunshot Fracture of the Clavicle. The ball ranged from before backward and upward, comminuting the outer half of the clavicle.