Immediate amputation is, so to speak, never indicated in traumatisms through bullets.
It is only admissible in cases of confirmed gangrene . In the most comminuted fractures, neither very extensive damage of the soft parts, nor an extreme condition of comminution of the diaphyses, nor supposed nor evident lesions of the large vessels, nor injury to important nerves, can be looked upon as indications for amputation. Immediate and atypical amputation can only be called for in cases of complete smashing or of almost total tearing off of a limb by a big projectile or by a big fragment . Confirmed traumatic gangrene . Rapid extension of emphysematous gangrene, which is almost generalized in one limb.