428 



ON EXCISION OF THE WRIST FOR CARIES 



when it can be dissected out without any considerable difficulty ; whereas its 

 intimate relations with the radial artery and its secure connexions with neigh- 

 bouring parts would cause a great deal of trouble at an earher stage of the 

 operation. The soft parts on the ulnar side of the incision are now dissected 

 up from the carpus as far as is convenient, the hand being bent back to relax 

 the extensor tendons of the fingers. The separation of these is, however, best 

 effected from the ulnar incision, which must be made very free. The knife is 



Fig. 4. — A , radial artery. B, tendon of extensor secundi inter- 

 nodii poUicis. C, indicator. D, extensor communis digitorum. 

 E, extensor minimi digiti. F, extensor primi internodii poUicis. 

 G, extensor ossis metacarpi pollicis. H, extensor carpi radialis 

 longior. 7, extensor carpi radialis brevior. K, extensor carpi 

 ulnaris. L L, line of the radial incision. 



entered at least two inches above the end of the ulna, immediately anterior 

 to the bone, and is carried downwards between it and the flexor carpi ulnaris, 

 and on in a straight line as far as to the middle of the fifth metacarpal bone 

 at its palmar aspect. The dorsal lip of this incision is then raised, and the 

 tendon of the extensor carpi ulnaris is cut at its insertion into the fifth meta- 

 carpal bone, and is dissected up from its groove in the ulna, care being taken 

 to avoid isolating it from the integuments, which would endanger its vitality. 

 The extensors of the fingers are then readily separated from the carpus, and 

 the^dorsal and internal lateral ligaments of the wrist-joint are divided ; but 



