SHRAPNEL--PLATE 134. LOWER EXTREMITY. Gunshot Wound of the Left Knee, with Lodgment of the Missile. The outer tuberosity lay next to the photographic plate, with the knot in the localizing wire on the inside of the leg and farther away from the plate. The line of projection is transversely through the tuberosities. The shadow of the ball, as it is somewhat enlarged, not sharply defined, and of medium density, must lie about midway between the lines of the localizing wire or in the popliteal space just above and between the tuberosities, much nearer the popliteal surface than the bone. An accurate localization of the ball in a transverse line, however, would require an exposure of another plate in an antero-posterior line, but in this actual case the localization of the ball had to be made from this single plate, as only one exposure was made. The ball struck the border of the popliteal space of the femur just above the tuberosity, without energy enough to cause a fracture, deform the ball, or even to leave, as a mark of contact, metal particles of the ball. [Illustration: Plate 135.] SHRAPNEL--PLATE 135. LOWER EXTREMITY. Gunshot Wound of the Left Leg, with Lodgment of the Missile. The posterior surface of the leg lay next to the plate, as shown by the outline of the head of the fibula, but any estimate of distance from the plate, based on depth of the shadows, is of little value because there is no contrast between localizing-wire shadows in front of and behind the leg. The slightly enlarged shadow of the ball indicates it to be farther from the plate than it would be if it lay behind the fibula. As the shadows of the metal fragments on the tibia are not sharp enough to indicate their position to be near the plate, the ball has lodged anteriorly between the tibia and fibula after ricocheting from the anterior surface of the tibia. The ball, being undeformed, struck the tibia with so little force that it barely penetrated the skin. The reaction of infection in such wounds makes a diagnosis on physical examination difficult and indicates radiography. [Illustration: Plate 136.] SHRAPNEL--PLATE 136. LOWER EXTREMITY. Gunshot Wound of the Leg, with Lodgment of the Missile. The leg lay with its posterior surface next to the photographic plate. The enlarged shadow of the ball and the blurred outlines of the metal fragments require them to be some distance from the plate and therefore on the anterior surface of the tibia. The impact has been from within outward with so little energy that the ball only touched the internal border of the tibia and lodged beneath the skin. Without the reaction of inflammation and infection, diagnosis could be made by palpation, but extensive swelling indicates radiography. [Illustration: Plate 137.] SHRAPNEL--PLATE 137. LOWER EXTREMITY. Gunshot Fracture of the Tibia and Fibula.