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
Every variety of _fracture of the clavicle_ was met with, even
perforation of the most compact portion of the shaft; comminuted, wedge,
or notched fractures were, however, the more common, and were
accompanied by the development of very large masses of provisional
callus during the process of healing. An interesting skiagram is
reproduced in plate III., which shows a compound form of injury to the
clavicle. The bullet has passed obliquely beneath the acromial end,
rising to perforate the posterior compact margin, and producing one of
the diamond-shaped openings sometimes occurring in compact bone with the
passage of bullets at a low rate of velocity. No case of perforation of
the subclavian vein by comminuted fragments of the clavicle came under
my notice.
_Fractures of the humerus_ of every variety were common, and I think
when the statistics of the campaign are published, it will be shown that
the humerus was the most frequently injured individual bone in the whole
body. I remember to have seen thirteen fractures of the shaft of the
humerus in one pavilion alone at Wynberg after the battle of Paardeberg.
Perforations of the upper articular extremity were common, and as a rule
gave rise to wonderfully little trouble in the shoulder-joint. The outer
aspect of the head of the humerus is a common situation for the
production of a special form of broken canal or groove (fig. 53). The
slope from the greater tuberosity to the shaft naturally favours the
production of the injury in this position.
I saw only one case in which a vertical fissure extended from a fracture
of the shaft into the shoulder-joint; in this case the transverse
solution of continuity was at the upper part of the middle third of the
bone. Skiagram, plate IV., illustrates a well-marked stellate
comminution of the shaft with large fragments. Plate V. shows extreme
comminution with fragments blown out of the wound. Two plates, Nos. VI.
and VIII., illustrate well the difference resulting from the oblique
passage of a bullet at high and low rates of velocity respectively. In
both cases good results were obtained; in the more severe the resultant
mass of ensheathing callus was very large, temporarily interfered with
flexion of the elbow-joint, and consolidation was very slow (see plate
VII.). The patient was wounded at Belmont in November 1899, but he was
able to row at the end of the summer of 1900, although very prolonged
suppuration occurred, and the elbow movements became practically normal.
Plate IX. illustrates a transverse track, the bullet having undergone
considerable injury during its passage through the bone, as evidenced by
the presence of fragments both of mantle and lead in the limb. This
might be called an example of transverse fracture, and illustrates the
nearest approach to one seen when the bone is struck fairly plumb.
[Illustration: PLATE IV.
Skiagram by H. CATLING
Engraved and Printed by Bale and Danielsson, Ltd.
(24) COMMINUTED FRACTURE OF THE HUMERUS
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