Surgical Experiences in South Africa, 1899-1900: Being Mainly a Clinical Study of the Nature and Effects of Injuries Produced by Bullets of Small CalibreMakins, George Henry
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Surgical Experiences in South Africa, 1899-1900: Being Mainly a Clinical Study of the Nature and Effects of Injuries Produced by Bullets of Small Calibre
Makins, George Henry
Gunshot wounds; South African War, 1899-1902; Surgery, Military
Again, it was rare for fissuring to extend from these tunnels to the
articular surfaces; thus many instances could be given of perforation of
the head of the humerus, the olecranon, or the femoral condyles, in
which no evidence of joint fissure was discoverable. The slight amount
of resistance offered by the cancellous ends was also clinically
illustrated by the absence of severe synovial effusions when they were
struck. When the joint cavity was not crossed, slight effusion only
resulted, while in the case of fractures of the femoral shaft great
effusion into the knee-joint, resulting from the forcible vibration
transmitted to the limb, was a common feature, even when the point
fractured was situated above the centre of the bone. Again, when the
joint cavity was crossed a moderate degree only of haemarthrosis was the
most common result.
With regard to the implication of joints, either primary or secondary,
in connection with fractures of the articular ends, I am inclined to
place the lesions of the upper end of the tibia in a more important
position than those of any other bone. Evidence of this implication was
in my experience more frequent here than in any other situation. This
may in part be attributable to the complexity of structure of this
epiphysis, and perhaps more correctly to the influence of its irregular
outline in favouring lateral forms of impact on the part of the bullet
and consequent increase in the area of damage.
Next to tunnelling, grooving was the most common form of injury to the
short bones. In the case of superficial tracks the compact tissue might
be considerably comminuted, but not, as a rule, over a width greatly
exceeding the calibre of the bullet.
Comminution and crushing of a single or several bones were rare in
proportion to the occurrence of similar injuries produced by
Martini-Henry or large leaden bullets. When the condition was produced
by bullets of small calibre, I believe it was in the majority of cases
the result of irregular impact on the part of the projectile. In support
of this view it may be added that such injuries were most common in the
bones of the tarsus, bones especially liable to be struck by ricochet
bullets.
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