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
Plate XV. illustrates an obliquely comminuted fracture of another
character. The bullet has here been stripped of its mantle, which has
undergone fragmentation, but the leaden core is little altered in shape.
This is of much interest, since it shows that the bullet struck the bone
by its side. The effect of such lateral impact on the part of the
projectile is well shown: there is great bone comminution of a less
regular character than usual, and the bullet is retained. Retention in
this case was probably not a result of low velocity of flight, but of
the increased resistance offered by the broad area of bone struck, and
the check exerted on the axial rotation of the bullet by the lateral
contact.
[Illustration: PLATE XIII.
Engraved and Printed by Bale and Danielsson, Ltd.
(31_a_) THE FRACTURE SHOWN IN PLATE XII., SIX MONTHS AFTER RECEPTION OF
THE INJURY
The amount of callus furnished around the loose fragments is very
striking.
The upper end of the bone is shown to have been divided into at least
two fragments, hence one of the difficulties of maintaining the ends in
apposition. The stoppage of the fissuring short of the epiphysis is
characteristic.]
Slighter injuries to the femur in which the shaft was chipped or grooved
without loss of continuity were not uncommon, and showed well the
capacity of the bone to withstand the lateral shock transmitted by small
bullets. Two figures inserted in the chapter on wounds in general (figs.
22, 23, pp. 61, 62) are of cases in which, from the appearance of the
wound of exit, the bullet probably underwent deformation, or was so
deflected as to escape on a considerably altered axis. Beyond the nature
of the exit wound in the case depicted in fig. 22, some thickening
beneath the femoral vessels denoted bone injury, but unfortunately no
skiagram was taken.
I saw no case in which a transverse fracture of the shaft accompanied
such injuries, but am under the impression that, if they had been
produced by bullets of greater volume and weight, transverse solution of
continuity would have been more common. In point of fact, no case of
pure transverse fracture of the femur ever came under my notice.
The diagram depicted in fig. 51, p. 164, is from a sketch made of the
lower end of a femur in which a severely comminuted fracture followed by
suppuration necessitated an amputation of the thigh, performed by Major
Lougheed, R.A.M.C. It is inserted as an illustration of the tendency of
the fissures to stop short above the actual articular extremities of the
bones. In this case the comminution was extreme and accompanied by the
usual long lateral fragments, one of which measured five inches in
length and might well have extended into the knee-joint had that been an
ordinary occurrence.
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