With the posterior aspect of the thigh lying next to the plate, the very greatly enlarged shadow of the deformed shrapnel ball indicates that it lies a relatively great distance from the plate, so that its location can be determined to be near the internal border of the adductor muscles, anteriorly, and below the transverse plane of the lesser trochanter. [Illustration: Plate 117.] SHRAPNEL--PLATE 117. LOWER EXTREMITY. Gunshot Wound of the Thigh, with Lodgment of the Missile. With the sacrum lying next to the plate, the normal size, clear outline, and dense shadow of the shrapnel ball indicates its position to be near the plate. The location can be roughly estimated as the superficial gluteal region, external to the ramus of the ischium and near the aerior plane of the upper border of the acetabular cavity. [Illustration: Plate 118.] SHRAPNEL--PLATE 118. LOWER EXTREMITY. Gunshot Wound of the Thigh, with Lodgment of the Missile. The normal size, distinct outline, and considerable density of the shadow of the shrapnel ball show that it lies very near the plate, posterior to the bone and in the buttocks, quite superficially. The treatment in such cases is always conservative. Pain or impairment of function indicate removal after convalescence. [Illustration: Plate 119.] SHRAPNEL--PLATE 119. LOWER EXTREMITY. Gunshot Fracture of the Femur, with Lodgment of the Missile. The direct subtrochanteric impact disintegrated the missile and delivered all of its energy to the bone, with a resulting transverse fracture of the upper end of the shaft of the femur and longitudinal fragmentation of the shaft. The course of the shrapnel ball was from behind forward and from above downward, as is shown by the track of the metal fragments and the lodgment of a larger lead fragment on the shaft below the seat of fracture. The uppermost large lead fragment, as shown by the depth of its shadow, lies farther behind the bone and nearer to the photographic plate than do the other pieces of the ball, as indicated by their lighter shadows. All of the fragments seem to lie behind the bone. The conservative treatment of this wound is justified by the attempt at repair, as indicated by the callus formation; but it is manifest, from the extremely faulty position, that the indication for immobilization and extension in strong abduction were not appreciated. Proper management of conservative treatment in such cases gives good results. [Illustration: Plate 120.] SHRAPNEL--PLATE 120. LOWER EXTREMITY. Gunshot Fracture of the Femur, with Lodgment of Multiple Missiles.