The fragments have been removed. The particles of metal which mark the path of the ball lie in front of the acromion process of the scapula, because lack of density and indistinct outline of the shadows show them to be farther from the photographic plate than the spine of the scapula which rested on the plate, escaping the imminent danger of wounding the subclavian vessels. The treatment is conservative and results are favorable. [Illustration: Plate 87.] SHRAPNEL--PLATE 87. UPPER EXTREMITY. Gunshot Fracture of the Humerus. The missile struck the bone and caused a long, splitting fracture, with some fragmentation of the proximal fragment. The wound could have been caused by either a ricocheted rifle bullet or by a deformed shrapnel ball, either projectile being the low velocity of long range. These conditions are more common to shrapnel wounds, but the appearance of the larger metal fragment leads to the suspicion that it is a piece of the jacket of a rifle bullet. The wound was not infected, and convalescence is well advanced, as is indicated by the callous formation. [Illustration: Plate 88.] SHRAPNEL--PLATE 88. UPPER EXTREMITY. Gunshot Fracture of the Humerus, with Lodgment of the Missile. The missile struck the shaft of the humerus from an anterior and external direction and caused a long diagonal splitting fracture with fragmentation, in which the bone absorbed all of the energy of the missile at the seat of fracture. The missile lies in the anterior surface of the humerus, in two fragments; the smaller, much less distinct, is seen about an inch above the larger. The wound is not infected, and convalescence is well established, as is indicated by the callous formation, with overlapping of the fragments. The treatment in such cases is conservative and the results are favorable. [Illustration: Plate 89.] SHRAPNEL--PLATE 89. UPPER EXTREMITY. Gunshot Fracture of the Humerus. The course of the missile was from behind forward and outward, striking the bone on the posterior surface, causing a fracture with fragmentation, and lacerating the wound of exit with fragments of bones and with its own deformation. The wound of exit is indicated in the plate. The wound is infected. Fragments of the missile lie on the posterior surface of the bone, as indicated by their dense shadow and distinct outline. The treatment in such cases is conservative and the results are favorable. [Illustration: Plate 90.] SHRAPNEL--PLATE 90. UPPER EXTREMITY. Gunshot Fracture of the Left Humerus. The course of the missile was transverse from without inward, with a transverse fracture and fragmentation. This wound might have been caused by either a shrapnel ball or a deformed rifle bullet, but the distribution of the metallic fragments rather indicate the course of a shrapnel ball.