The treatment in such cases is conservative. Results as to function are uncertain. [Illustration: Plate 104.] SHRAPNEL--PLATE 104. UPPER EXTREMITY. Gunshot Fracture of the Ulna. The course of the missile was tangential along side of the upper end of the ulna and internal condyle of the humerus, with a splitting effect on the ulna, which formed three fragments by breaking off the olecranon, and one lateral fragment from the shaft of the bone without displacement. The line of metallic particles shows the path of the ball in its slight contact with the bones, beginning on the side of the ulna and extending along the side of the internal condyle from where the ball escaped through the skin. The wound, not infected, was treated as simple fracture. A few fine lines on the plate above the fracture are due to scratches on the negative. Results in such cases should be good. [Illustration: Plate 105.] SHRAPNEL--PLATE 105. UPPER EXTREMITY. Gunshot Fracture of the Right Metacarpus. The course of the missile was from the outer border of the hypothnear eminence diagonally downward through the palm, lodging against the second metacarpal bone with fracture of last four metacarpals. The metal particles are not seen on the fourth and fifth metacarpals because the violence at these points was transmitted through soft parts, but the projectile spent its remaining energy directly against the second and third metacarpals. The palm of the hand was next to the photographic plate, as indicated by the immediate contact of the thumb. The shadow of the bones is not dense, but in deep contrast with the shadows of the ball and metal fragments, which are so clearly outlined with the ball of normal size that the ball is thus shown to lie on the palmar side of the hand. The treatment is conservative, with judicious interference when opportunity shall offer for removal of the missile. [Illustration: Plate 106.] SHRAPNEL--PLATE 106. UPPER EXTREMITY. Gunshot Fracture of the Left Metacarpus, with Lodgment of the Missile. The palm of the hand lies next to the plate. The ball is very slightly enlarged and the small metal fragments are indistinct, indicating that they and the ball lie on the back of the hand. The ball struck the third knuckle and lodged beneath the skin between the fourth and fifth metacarpals, fracturing both bones without displacement of fragments. In the recent wound the condition would be apparent, but after days of inflammatory reaction and infection, the swelling is too great to make any determination by palpation. The treatment is removal of the missile. Good results regularly follow. [Illustration: Plate 107.] SHRAPNEL--PLATE 107. UPPER EXTREMITY. Gunshot Fracture of the Left Metacarpus, with Lodgment of the Missile.