The position of the femur is in outward rotation, as shown by the full shadow of the lesser trochanter and the vanishing of the greater trochanter behind the shoulder of the neck. The two larger missiles lie on the outer side of the bone and the others lie in front on the seat of fracture. The greatly deformed shrapnel balls and the slight chipping fracture of the femur indicate that the greater portion of the striking energy of the missiles was so dissipated in ricochet that but little force was left for attack on the bone. The treatment in such cases is expectant and indication rarely arises for search for and removal of the missiles. [Illustration: Plate 121.] SHRAPNEL--PLATE 121. LOWER EXTREMITY. Gunshot Fracture of the Shaft of the Femur, with Lodgment of the Missile. The course of the shrapnel ball was from within outward, striking the femur with the energy of high (shrapnel) velocity, with fragmentation of the missile by impact on the bone. The largest fragment, by the distinct outline of its shadow, lies close to the plate and behind the bone; a smaller metal fragment has been carried to the outer border of the thigh, where it lies superficially; another fragment lies in the seat of fracture. The position of fragments is faulty, as the indications for extension and abduction have not been wholly met, although this is a case from the well-conducted service of Gulhané Hospital. The treatment in such cases is conservative and the results are good. [Illustration: Plate 122.] SHRAPNEL--PLATE 122. LOWER EXTREMITY. Gunshot Fracture of the Shaft of the Femur, with Lodgment of the Missile. The shrapnel ball, in its almost directly antero-posterior course from behind forward, has delivered the energy of high (shrapnel) velocity to the bone, which had absorbed it all in stopping the missile, with a resulting approach to a butterfly fracture with displacement of fragments. The upper end of the lower fragment lies nearer to the plate than to the lower end of the upper fragment, with the deformed shrapnel ball lying behind the latter, closer to the plate. The treatment in such cases is conservative, with good results to follow except as they may be imperiled by infection. [Illustration: Plate 123.] SHRAPNEL--PLATE 123. LOWER EXTREMITY. Gunshot Fracture of the Femur, with Lodgment of the Missile. While the missile in this case may have been other than a shrapnel ball, the fracture is one produced by the impact of a missile delivering great striking energy, with a predominant cross-section factor in its composition. The fragments are due to the application of an energy in which the mass was distributed over a relatively large area on bone, which resulted in the displacement of the large fragments. The treatment in such cases is conservative. Results are favorable; infection is generally controlled. [Illustration: Plate 124.] SHRAPNEL--PLATE 124. LOWER EXTREMITY.