226 SURGICAL APPLIED ANATOMY. [Chap. XIIL 



The connection also of this muscle with the ulna 

 through the anconeus should be as little disturbed as 

 possible. It is never necessary to divide the insertion 

 of the brachialis anticus, still less of the biceps, 

 although some few fibres of the former muscle may be 

 separated in removing the upper surface of the ulna. 

 As regards the future usefulness of the new joint, it 

 is most desirable that the cut surface of the humerus 

 should be as broad as possible. By the subperiosteal 

 method of Oilier and others the periosteum is care- 

 fully peeled off from all the parts to be resected, and 

 is preserved. By this means the triceps retains a 

 good hold upon the ulna, and the restoration of the 

 joint is more complete. The functions of the joint 

 may be remarkably restored after resection, especially 

 when performed by the sub-periosteal method, but it 

 would appear that after no method are the anatomical 

 details of the articulation reproduced. Thus, in a 

 successful case, the new joint will assume the bi- 

 malleolar form, and will resemble the tibio-tarsal 

 rather than the normal elbow joint. The humerus 

 throws out two malleoli on the sites of the normal 

 condyles, and in the concavity between these pro- 

 cesses the ulna and radius are received. The ends of 

 these latter bones are smoothed and rounded, and 

 between the ulna and the humerus new ligaments 

 form. A new annular ligament for the radius is also 

 developed. 



