A manual of operative surgery . afterbeing partially divided or peeledoff the bone. In this stage care must betaken of the biceps tendon, whichshould be drawn aside. Clearing of the Neck of theBone.—The biceps tendon is dis-placed inwards. The elbow isflexed, and the arm is held ver-tically ( at right angles to thetable), and is thrust upwards sothat the head of the bone is exposed while the two edges of thedeep wound are forcibly retracted. The posterior part of the neckof the bone is cleared, and the parts are prepared for the actualresection. It will be understood that this is performed
A manual of operative surgery . afterbeing partially divided or peeledoff the bone. In this stage care must betaken of the biceps tendon, whichshould be drawn aside. Clearing of the Neck of theBone.—The biceps tendon is dis-placed inwards. The elbow isflexed, and the arm is held ver-tically ( at right angles to thetable), and is thrust upwards sothat the head of the bone is exposed while the two edges of thedeep wound are forcibly retracted. The posterior part of the neckof the bone is cleared, and the parts are prepared for the actualresection. It will be understood that this is performed whilethe head of the humerus is still in the joint-cavity. Formerlyit was recommended that the humeral head should be thrustthrough the wound, but this cannot be effected unless the rotatorand small elevator muscles have been wholly divided. Excision of the Head of the Humerus.—This can be bestdone with a broad chisel or Heys saw. All the diseased articularsurface should be cut away, and if the operation is being performed. FIG. 475.—EXCISION OF THE SHOULDER, A, Incision of Bauden, Hueters, an3Oilier ; B, Vertical incision ofLangen-beck and others. 750 OPERATIONS ON BONES AND JOINTS [part vii for tuberculous disease it will probably be found that this extendsto some depth into the head of the bone. As much of the latteras can safely be left should be preserved, and it is a good planto make the section slightly convex upwards (see Fig. 474).I (J. H.) have found a chisel and gouge the most convenientinstruments. The glenoid cavity is examined, and its diseased surfacegouged away. The skin incision is closed with sutures, andthe limb placed in position. It should be noted that, so long as all diseased bone andsynovial membrane is removed, the insertions of the rotatormuscles should be interfered with as little as possible. Thesynovial pouches in connection with the subscapularis and biceps
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