The metallic fragments lie farther from the plate than the safety pin of the dressing, which, therefore, lies behind the bone and the fragments of the missile lie in front. The treatment in such cases is conservative and the results are favorable. The subsequent course may indicate interference for mal-union. [Illustration: Plate 91.] SHRAPNEL--PLATE 91. UPPER EXTREMITY. Gunshot Fracture of the Left Humerus. The course of the missile has been from without inward. The fragments of metal marking the path of the missile lie farther from the plate on the outer than on the inner side. This would indicate the former to be in front of the bone and the latter to be behind. The wound could have been caused by either a deformed rifle bullet or by a shrapnel ball, but the distribution of metallic fragments along the track of the missile rather indicates the agent to have been a shrapnel ball. The case is similar in course and results to that shown in the preceding plate 90. [Illustration: Plate 92.] SHRAPNEL--PLATE 92. UPPER EXTREMITY. Gunshot Fracture of the Right Humerus, with Lodgment of the Missile. The missiles, shrapnel balls deformed by ricochet, were multiple, with a course from without inward and diagonally downward. The streaks of metal particles along the seat of fracture indicates the path of a shrapnel ball or fragment from the point of impact to the lower fragment of the fracture, where several deformed shrapnel fragments are lodged. Multiple wounds by shrapnel are common. The wounds of entrance were small. There was no wound of exit. The wound was not infected. This is another evidence that does not defend the inference that ricocheted missiles are prone to introduce elements of infection into a wound. The plaster dressing does not seem to meet the indications for support of the fracture. The treatment is conservative in such cases. Results are favorable. [Illustration: Plate 93.] SHRAPNEL--PLATE 93. UPPER EXTREMITY. Gunshot Fracture of the Right Humerus. The course of the missile was transverse, from without inward and downward, striking the shaft of the bone squarely and producing a characteristic “butterfly” fracture, with a separation of the fragments. The exposure was made with the ulnar side of the arm next to the plate, indicated by the clear outline of the internal condyle and the olecranon. The nearly normal size of the shadow of the shrapnel ball shows it to be near the plate, and therefore to lie on the inside of the humerus. The irregular outline of the ball and the metallic fragments spattered about indicate that the ball was deformed by the detachment of fragments on direct impact with the bone. The wound is not infected. The treatment is conservative in such cases and the results are good. [Illustration: Plate 94.] SHRAPNEL--PLATE 94. UPPER EXTREMITY. Gunshot Fracture of the Right Humerus.