Of _fractures of the hand_ I have little to say. In the case of the _carpus_, the slight degree of resistance offered by the bones rendered injuries of an explosive character rare. I never saw one. Fractures of the _metacarpus_, on the other hand, presented exactly the opposite features. The density of these small bones was well illustrated by the frequency with which the bullet suffered injury, even amounting to fragmentation, and the great comminution they themselves suffered. The breaking up of the bullet in these fractures was a curious feature, which may perhaps be explained by the tendency of the distal part of the limb to be driven in the course of the bullet, with the result of somewhat lengthening the period of contact of the projectile, or more probably by somewhat frequently occurring irregular impact. Plate XI. is a good example of an injury of this nature of moderate severity. The soft parts suffered much in these injuries, the tendons were torn and lacerated at the moment, and were very apt to acquire more or less permanent adhesion. This latter condition was sometimes to be improved by the removal of bone fragments, and I have freed tendons from actual clefts in the bones where they had been carried in by the bullet. In some cases very great deformity of the digits, due to shortening, developed, even when no fragments were removed beyond those blown away by the bullet. One form of injury of some interest was multiple fracture of the phalanges produced by a bullet travelling in a course parallel to the length of the rifle when pointed by the patient. Occasionally several digits were lost. _Treatment of fractures of the upper extremity._--The general lines of this have already been foreshadowed in the general section, the remarks as to transport being applicable to all serious fractures of the shaft of the humerus, and this is the only one of the bones of the upper extremity on which anything special need be said, as the treatment of all the other fractures exactly coincides with that of ordinary civil practice. [Illustration: PLATE VII. Engraved and Printed by Bale and Danielsson, Ltd. (26_a_) CONDITION OF THE SAME FRACTURE SHOWN IN PLATE VI., A YEAR AFTER ITS PRODUCTION The ensheathing callus is still very abundant, but less so than at an earlier date. No trouble with the musculo-spiral nerve was noted, but residual abscesses occurred from time to time in connection with the fracture.] [Illustration: FIG. 54.--German Wire Gauze Splint on steel wire foundation. (German Ambulance, Heilbron)]