The course of the missile was from behind forward, causing a transverse fracture of the humerus with some fragmentation. The wound is in a state of established convalescence, with considerable separation of the ends of the large fragments and without infection, shown by the formation of callus and by an attempt at union in faulty position. The trail of the metallic fragments of the missile from behind forward and their location near the anterior surface of the arm indicate the course of the missile, either a rifle bullet or a shrapnel ball--most probably the latter, as the lead core of the rifle ball, protected by the jacket, does not break up into as many small particles as does the shrapnel ball. The missile was deformed by ricochet before striking the bone. The early treatment in such cases is conservative, although the subsequent course may indicate interference for malposition. The results are favorable. [Illustration: Plate 95.] SHRAPNEL--PLATE 95. UPPER EXTREMITY. Gunshot Wound of the Humerus, with Lodgment of the Missile. The course of the missile was from before backward. The missile consisted of two large fragments of a richocheted shrapnel ball, almost spent in energy before striking the arm, as its penetration was just enough to pass through the soft parts and strike the humerus, causing a fissure without separation of fragments. The wound was clean. The treatment in such cases is naturally conservative. [The epiphysis of the olecranon being so distinct and showing no fusion, indicates the youth of this soldier, whose age could not have been more than 16 years.] [Illustration: Plate 96.] RIFLE--PLATE 96. UPPER EXTREMITY. (a) Gunshot Fracture of the Left Humerus--(b) Gunshot Fracture of the Left Elbow. The missile was a rifle bullet with the reduced velocity of long range, passing transversely along the articulations of the elbow, fragmenting the radius and ulna and fissuring the humerus through both condyles. The emergency treatment is antiseptic dressing and immobilization, with prompt transportation to the base. Subsequent treatment is conservative, with proper immobilization. Results as to limb are favorable, with probable loss of function of the elbow. [Illustration: Plate 97.] SHRAPNEL--PLATE 97. UPPER EXTREMITY. Gunshot Wound of the Right Elbow. The course of the missile was superficial, downward and outward from above the internal condyle of the right humerus to the wound of exit over the internal border of the ulna. Metal fragments of the missile have lodged against the tip of the olecranum, with no fracture and with no damage to the joint. The low velocity of the missile, producing so slight a bone injury and the track of lead particles along the line of contact with the bones determines it to have been a shrapnel ball. The wound was not infected. The treatment in such cases is naturally conservative and the results are very favorable. [Illustration: Plate 98.] SHRAPNEL--PLATE 98.