. Operative surgery. of articu-lation of the wrist Joint; expose thetendon of the extensor indicis withoutopening the sheath, draw it gently out-ward by the aid of a hook, and locatethe insertion of the extensor carpiradialis brevior; expose the base of thethird metacarpal bone at the radialside of the last-named tendon; dividethe posterior annular ligament andopen the capsule of the joint betweenthe tendons of the extensor indicisand extensor longus pollicis; drawthe former tendon outward along withthose of the extensor longus digi-torum ; make an ulnar incision downto the bones at the inner
. Operative surgery. of articu-lation of the wrist Joint; expose thetendon of the extensor indicis withoutopening the sheath, draw it gently out-ward by the aid of a hook, and locatethe insertion of the extensor carpiradialis brevior; expose the base of thethird metacarpal bone at the radialside of the last-named tendon; dividethe posterior annular ligament andopen the capsule of the joint betweenthe tendons of the extensor indicisand extensor longus pollicis; drawthe former tendon outward along withthose of the extensor longus digi-torum ; make an ulnar incision downto the bones at the inner side of thetendon of the extensor carpi ulnaris,from a point an inch and a quarterabove the tip of the styloid process tothe same distance below the base ofthe fifth metacarpal bone, avoidingthe nerves going to the little finger;through the incision already made di-vest the carpal bones of their ligamentous and periosteal coverings by smallrugines preferably introduced first at the radial side; free the bones, expose. Fig. 417.—Excision of wrist joint. incision. 3, 3. Olliersincisions. 1, 4. Boeckels incisions, ligament, h. Extensor carpiradialis brevior. c. Extensor carpiradialis longior. d. Extensor longuspollicis. e. Extensor communis digi-torum. /. Extensor indicis. g. Ex-tensor carpi ulnaris. 404 OPERATIVE SURGERY. and remove them through the corresponding incisions, saving if possiblethe pisiform, the unciform process, and the trapezium; bare the radius andulna of periosteum as high up as needful, protrude the ends through theopening and divide them with a saw. The Comments.—In recent injuries it is difficult indeed to separate thetissues from the bones, especially in adult subjects. In young subjects andin those in whom the parts are affected with chronic inflammation, the sepa-ration is easier. The tendons and their insertions are preserved much betterin the subperiosteal than in the open method. The Operation of Complete Excision of the Wris
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