The line of projection of the shadow is directed obliquely from behind, focussed on the internal aspect of the knee, with the fibula next to the plate. As the shadow of the shrapnel ball is much enlarged and not very dense, the ball must lie some distance from the plate and away from the fibular side of the joint. As the distances through the knee joint are about the same in all cases and as shrapnel balls are approximately the same size, it is evident that the ball lies farther away from the plate than it does in plate 129, where it is about the middle of a transverse line through the joint. It must lie, therefore, superficially between the head of the tibia and the internal condyle of the femur. Removal is indicated under favorable surgical conditions. Infection of the joint may occasionally indicate drainage and removal as emergency treatment. Results, except for infection, are good. [Illustration: Plate 131.] SHRAPNEL--PLATE 131. LOWER EXTREMITY. Gunshot Wound of the Knee, with Lodgment of the Missile. That the knee is not fully extended is shown by the exaggerated outline of the tibial head. The enlarged and only fair density of the shadow indicates that the shrapnel ball lies some distance away from the plate. As the bone is not injured, the missile must lie either in front of or behind the femur, and its enlarged shadow shows the position to be in front of the femur, just above the articular surface, and probably within the reflection of the capsular ligament. A comparison with the size of the shadows of the balls shown in plates 128 and 130 will show this one to be greater than the former and less than the latter, and so it must bear about the same relation in the distance from the plate. This would account for the location in front instead of behind the femur. The treatment is conservative, and removal is indicated when function is disturbed. [Illustration: Plate 132.] SHRAPNEL--PLATE 132. LOWER EXTREMITY. Gunshot Wound of the Knee, with Lodgment of the Missile. The fibular side of the leg lay next to the photographic plate, as shown by the enlarged fainter outline of the internal tuberosity. The shadow of the shrapnel ball is neither as normal in size as that of the external condyle nor as exaggerated as that of the internal condyle, and the position is probably neither as close to the plate as the former nor as far away as the latter. The missiles lie about the middle of the anterior surface of the lower end of the femur, above the articular surface. [Illustration: Plate 133.] SHRAPNEL--PLATE 133. LOWER EXTREMITY. Gunshot Wound of the Right Knee, with Lodgment of the Missile. The ball struck the outer condyle just above the articular surface with only enough energy to damage and slightly crack the bone. The injury to the bone and the metallic mark of the impact can be seen just above the outer border of the articular cartilage of the outer condyle. [Illustration: Plate 134.]