250 SURGICAL APPLIED ANATOMY, ici^p. xm. 



radius is entirely within the limits of the annular 

 ligament, and could scarcely be separated in a simple 

 lesion. It is a mere disc of cartilage joining the shaft 

 at the age of seventeen. When the neck is broken 

 the upper end of the lower fragment is drawn well 

 forwards by the biceps muscle. 



Resection oil lie elbow may be performed in 

 many ways. In all procedures there is danger of 

 injuring the ulnar nerve, and some little difficulty 

 often in clearing the prominent internal condyle. If 

 the knife be kept close to the bone, no vessel of any 

 magnitude should be divided. The muscles most dis- 

 turbed are the triceps, anconeus, supinator brevis, 

 extensor carpi ulnaris, extensor carpi radialis brevior, 

 and brachialis anticus. It is most important to pre- 

 serve the periosteum over the olecranon, so that the 

 triceps may still have some attachments to the fore- 

 arm. 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. By the 

 subperiosteal method the periosteum is carefully peeled 

 off from all the parts to be resected, and is preserved. 

 By this means the triceps retains a hold upon the 

 ulna, and the restoration of the joint is more complete. 

 The functions of the joint may be well restored after 

 resection, especially when performed by the subperios- 

 teal method, but it would appear that after 110 method 

 are the anatomical details of the joint reproduced. 

 Thus, in a successful case, the new joint will assume 

 the biuialleolar form, and will resemble the ankle 

 rather than the elbow joint. The humerus throws 

 out two malleoli on the sites of the normal condyles, 

 and in the concavity between them the ulna and radius 

 are received. Between the ulna and the humerus 

 new ligaments form, and a new annular ligament for 

 the radius is also developed. 



