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
In spite of a considerable experience, I never saw a case of perforation
of either the head or neck of the thigh bone. I saw numerous tracks
emerging at the side of the femoral vessels and entering at the buttock
or vice versa, but never one accompanied either by effusion into the
hip-joint or impairment of movement. Considering the regularity with
which haemarthrosis occurred when the other joints were crossed, and also
the nature of the compact tissue of the neck of the femur, which must
have ensured some splintering, I do not think I can have overlooked an
injury of this nature. No doubt also the escape of the neck of the bone
was explained in some of the cases by the fact that the injuries were
received while the hip-joint was in a position of flexion, the bullet
passing over the neck of the femur. In two cases of extensive
comminution of the upper third of the femur that I saw, the fissures
stopped short at the inter-trochanteric line anteriorly, but in one of
them a large angular fragment was torn out of the posterior surface of
the neck.
Excepting transverse fracture every form was met with in the shaft,
although I saw only two instances of perforation. One has been already
alluded to and was situated in the broadening portion of the lower
third, the bullet taking an antero-posterior course. The second is seen
in plate XVII.
Plate XII. shows an instance of extreme comminution of the upper third
accompanied by the presence of two typical elongated fragments. The
course taken by the bullet was almost directly antero-posterior, and the
wounds were of moderate size even in the case of the exit one. This
seems to preclude the possibility of the injury having been produced by
a ricochet bullet, while the fact of perforation and escape of the
bullet in spite of the serious damage suffered by the mantle points to
the injury having been produced at a short range of fire. The patient
himself owns to being quite unable to give any estimate of the distance.
Although no suppuration occurred, this fracture was very slow in
consolidating, and the free comminution with consequent inaccurate
apposition led to the development of four inches shortening of the limb.
The skiagram was taken about six weeks after the occurrence of the
injury, a few days after I first saw the patient; I have, however, had
the opportunity of seeing a second skiagram taken some four months
later. This is of considerable interest, as throwing light on the mode
of union of such fractures. The two elongated fragments in the later
skiagram are widened to three times their original breadth, and form
buttresses on either side of the point of union, while the irregular
ends of the shaft are rounded off, and the mass of fine fragments behind
is consolidated. Beyond this the second skiagram shows that the upper
fragment, apparently intact in the first, was really split
longitudinally, and therefore was far less useful as a point of support
Public-domain text, read in full here on John Shaqi.
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