UPPER EXTREMITY. Gunshot Fracture of the Right Elbow, with Lodgment of the Missile. The course of the ball was from before backward, striking the lower end of the humerus squarely above and internal to the external condyle and splitting off the condyles with a line of fracture extending through the capitellum, without much separation of the fragment. As the impact was direct, the energy producing such effect was that of low velocity. The great radiographic penetration shown in this plate gives the shadows of the ball great distinctness and definite outline, especially in the line of fracture, although its opposite border is not in such sharp contrast. This appearance, together with the very slight enlargement, leads to the suspicion that the ball lies posteriorly, but a larger metal fragment, below the ball, is less clear and suggests a position anterior to the bone. With the posterior surface of the arm next to the plate and with but little difference in the distance from the plate to either the anterior or posterior surface of the bone, it is not easy to determine the location of the ball in the anteroposterior direction, but it would seem to be on the anterior surface of the bone. The wound is not infected. The treatment is conservative and results favorable. The subsequent course would probably indicate the removal of a foreign body from a site so near the joint. [Illustration: Plate 99.] SHRAPNEL--PLATE 99. UPPER EXTREMITY. Gunshot Fracture of the Right Elbow, with Lodgment of the Missile. Same wound as in plate 98. The sharp holder of the greater sigmoid cavity and the head of the radius fully obscured by the coracoid process indicate, that in this exposure, the ulnar side of the arm was next to the plate. With this condition and the enlarged shadow of the ball, the latter must lie a little distance away from the plate, and, actually, on the radial side of the humerus. The position of the ball in the anteroposterior line is manifest, and its position confirms the deductions made therefrom in the preceding plate (98). [Illustration: Plate 100.] SHRAPNEL--PLATE 100. UPPER EXTREMITY. Gunshot Fracture of the Elbow. The primary condition of this wound is not manifest from the appearance of the plate, which reveals only a destruction of the joint by fracture and an advanced stage of infection, involving the fragments and lower end of the shaft of the humerus, as indicated by the rarefaction of these parts. Several fragments of the missile are in evidence; it is probable that others have escaped with drainage. Drainage tubes are seen in the lower arm and upper forearm. The primary conservative treatment has been continued through two or three months. The case is from Gulhané Military Hospital, where the scientific character of surgical service already referred to must lead to the inference that all the surgical indications have been met in the management of the case. [Illustration: Plate 101.]