Gunshot Fracture of the Femur, with Lodgment of Multiple Missiles. The direct impact of two shrapnel balls, delivering all of their energy to the femur, resulted in a fracture with large fragments. The exposure was made through a plaster splint, and shows a faulty position with progressing repair. The treatment in such cases is conservative, but with respect for the indications to maintain proper position of the fragments. [Illustration: Plate 125.] SHRAPNEL--PLATE 125. LOWER EXTREMITY. Gunshot Fracture of the Femur, with Lodgment of the Missile. The condition shown in the plate is the characteristic result of direct impact of a projectile of low velocity and great sectional area in which all of the energy is delivered to the bone against which it lodges. The distinct outline and dense shadow of the deformed missile indicates its position to be behind the bone. The callus formation indicates the favorable progress of repair, but with the fragments in faulty position. The treatment in such cases is conservative, with proper respect to the principles of maintenance of normal relation of the fragments. [Illustration: Plate 126.] SHRAPNEL--PLATE 126. LOWER EXTREMITY. Gunshot Fracture of the Femur, with Lodgment of the Missile. The course of the shrapnel ball was antero-posterior, with an impact on the shaft of the femur, which fragmented both the ball and bone through the imparting or the entire striking energy of the ball to the bone by the lodgment of the ball. The sharp outline and density of the shadows of the missile, in contrast with the dense shadows of the bone, indicate that the missile lies closer to the plate than does the bone, although the flattened ball does not permit a comparison between its shadow and the normal size of the ball. The advanced stage of convalescence is shown by the formation of callous. The treatment in such cases is conservative and the results are good if proper position can be maintained. [Illustration: Plate 127.] SHRAPNEL--PLATE 127. LOWER EXTREMITY. Gunshot Fracture of the Shaft of the Femur. The impact of the missile was delivered with the energy of high (shrapnel) velocity at close range, as is indicated by the signs of another shrapnel wound, just above the outer tuberosity (in the lower left corner of the plate), where a deposit of metallic particle is evidenced. The fragmentation of the missile, through its contact with the bone, indicates the great striking force of a missile which ricocheted from the bone. The general distribution of metallic particles through a wound of this class indicates certainly that the missile was unjacketed, and the destructive forces show that its sectional area was relatively larger, i. e., a shrapnel ball.