REGION OF THE ELBOW. 301 



Pus first works its way posteriorly up behind the tendon of the triceps and then 

 sideways and along the intermuscular septa. As the external supracondylar ridge is 

 nearer the surface than the internal, pus will show itself sooner above the lateral 

 (external) condyle. It may form a protrusion on each side of the triceps tendon and 

 olecranon process. 



Later it may show itself anteriorly ; when it does so it appears more to the outer 

 than to the inner side, being deflected outwardly through the antecubital space by 

 the attachment of the brachialis anticus to the coronoid process, by the tendon of the 

 biceps and by the bicipital fascia which passes from the tendon over the muscles 

 attached to the medial (internal) condyle. 



RESECTION OF THE ELBOW. 



A straight incision is made over the point of the olecranon a little internal to its 

 middle. The upper portion of this incision splits the triceps. Its lower part is 



Olecranon 



Head of radius 



Capitellum 

 j -Trochlea 



Internal condyle 



Cut edge of capsule 



Ulnar nerve 



Cut edge of triceps tendon 



FIG. 3 1 6. Resection of the elbow- joint ; the ends of the bones are exposed ready to be removed. 



carried down to the bone on the posterior surface of the ulna. The attachment of 

 the triceps to the inner side is then dissected off and the ulnar nerve raised from its 

 groove without injuring it. The medial (internal) condyle is then to be cleared of 

 the muscles attached to it. The parts external to the incision are now to be raised. 

 By means of periosteal elevators aided by the knife the external part of the triceps is 

 detached from the bone as closely as possible, following exactly the edge of the ulna. 

 The anconeus is raised with the triceps and the broad fibrous expansion passing from 

 the olecranon to the lateral (external) condyle and thence over the anconeus to be 

 continuous with the deep fascia is preserved intact. On the care with which this is 

 done depends the amount of subsequent muscular control. As the triceps is turned 

 aside the muscles attached to the lateral condyle are raised in the same manner. The 

 soft parts being drawn to each side the bones are protruded and the remaining soft 

 parts anteriorly can be detached. A flat spatula is then passed beneath the bones 

 and the humerus sawed through opposite the upper edge of the medial (internal) 

 condyle above and the radius and ulna opposite the lower edge of the head of the 

 radius below. The insertions of the biceps and brachialis anticus are not disturbed. 



