The fibular side of the leg lay next to the plate, as the distinct and not exaggerated outlines of the fibula can be seen in the dense shadow of the tibia. The wound, as indicated by the callous tissue, is shown in a state of repair, after the larger detached fragments of the fracture had been removed. The wound was caused by a missile carrying considerable energy. The small particles of metal marking the course of the missile show it was a shrapnel ball. [Illustration: Plate 138.] SHRAPNEL--PLATE 138. LOWER EXTREMITY. Gunshot Fracture of the Right Tibia and Fibula. This plate shows a type of wound caused by a number of fragments of a shrapnel ball or other similar missile. The missile was deformed by a near-by ricochet, from which large and small fragments struck simultaneously and distributed themselves over a large area. The larger fragments carried enough energy to fracture the bone by transmitting all of their energy in lodgment and by possibly breaking up into smaller fragments. In this case the energy of the missile was transmitted to the tibia, with fracture and great fragmentation of the bone. The fracture of the tibia was secondary, resulting from indirect violence, due to the loss of the support of the tibia. [Illustration: Plate 139.] SHRAPNEL--PLATE 139. LOWER EXTREMITY. Gunshot Fracture of the Right Tibia and Fibula. The course of the missile was from within outward and from before backward, striking both the fibula and the tibia, with fragmentation and displacement of both bones. The fibula lay next to the plate, as indicated by its distinct normal shadow and the exaggerated outline of the internal malleolus. The trail of metal fragments is typical of a shrapnel ball with the energy of high shrapnel velocity, but any lead missile without a protective jacket, under like conditions, might have produced the same effect. The treatment is conservative until some positive indication arising in the course of an infection directs interference. [Illustration: Plate 140.] SHRAPNEL--PLATE 140. LOWER EXTREMITY. Gunshot Fracture of the Left Tibia and Fibula, with Lodgment of the Missile. As the heel lay on the plate it is easy to identity the tibia and fibula of the left leg. The course of the ball from the internal malleolus across to the lower end of the tibia and fibula is well marked by the trail of metal particles left by the contact of the ball with the bones. The indistinctness of the shadows of the lead particles and of the ball and the very slight enlargement of the ball indicates a contact with the anterior surface of the tibia and of the fibula with lodgment of the ball beneath the skin at the anterior border of the lower end of the fibula. The remaining energy of the missile was almost entirely spent on the tibia, causing a long oblique fracture, so that the contact with the fibula resulted in a crack only, without the separation of a fragment.