. Operative surgery. d the trochantermajor, and passing backward around the top of the trochanter major, downits posterior border about three or four inches; then dividing the insertionsof the muscles connected to the great trochanter (Fig. 447), drawing themaside with a spatula, and exposing the posterior surface of the neck of thefemur and the acetabulum. The exposure will be still more complete if thefemur be rotated strongly inward. If the cotyloid and capsular ligaments benow divided, and the thigh be flexed, adducted, and rotated outward, the headof the bone will be raised from the aceta
. Operative surgery. d the trochantermajor, and passing backward around the top of the trochanter major, downits posterior border about three or four inches; then dividing the insertionsof the muscles connected to the great trochanter (Fig. 447), drawing themaside with a spatula, and exposing the posterior surface of the neck of thefemur and the acetabulum. The exposure will be still more complete if thefemur be rotated strongly inward. If the cotyloid and capsular ligaments benow divided, and the thigh be flexed, adducted, and rotated outward, the headof the bone will be raised from the acetabulum sufficiently to admit of the OPERATIONS ON BONES. 42i division of the liganientiim teres, when the complete escape of the head ofthe femur will take place. The soft parts are then protected by a spatula,and the bone, exposed to the required extent, is sawed off (Fig. 448). A Conservative Method of Subperiosteal Excision of the Hip Joint(Langenbeck).—Place the patient on the sound side with the thigh flexed to. Fig. 448.—Sawing oflf head of femur. an angle of 45°, and rotated slightly inward; make a straight incision five orsix inches in length in the long axis of the great trochanter (Fig. 449), upwardand backward toward the posterior superior spine of the ilium, passingthrough the fascia lata, fibers of the gluteus maximus, and periosteum of thetrochanter; separate the surfaces of the wound with retractors, and with theelevator and knife raise the periosteum and the attachments of the musclesinserted into the trochanter major and the contiguous surfaces, being carefulto preserve their connections with each other; next make a longitudinal in-cision along the neck of the femur, through the capsular ligament and theperiosteum. The periosteum of the neck is then separated in connectionwith the attachments of the capsular ligament and the obturator externusin a careful manner. If an incision be now made through the cotyloid liga-ment, and the thigh be rotated outward and
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