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By Francesco Ruggieri M.D., Gian Franco Zinghi M.D., Stefano Boriani M.D., Luigi Specchia M.D. (auth.)

Our choice to devote a number of years to the writing of this Atlas used to be in accordance with the pro acknowledgement of destructive surgical effects because of improper or incomplete techniques to the bones or joints requiring remedy. we're confident that during order to procure the very best anatomic and sensible leads to surgical procedure of the locomotor equipment, it's important to obey a number of principles of behaviour con­ stituting the root for proper surgical execution: a) to appreciate the anatomy of the muscular and neural formations; b) to protect the vascularization of those anatomical parts and as a result of the osteoarticular equipment; c) to exploit the main applicable surgical techniques totally respecting the neighborhood anatomy and the least tense publicity of the skeleton; d) to properly practice surgical procedure, therefore developing the easiest stipulations for the excel­ lent restoration of the functionality of the limb. The anatomic findings and surgical methods to the extremities defined listed below are now not entire: we've established our number of the previous on their frequency within the general surgical task of any specialized ward, and the latter at the surgi­ cal ways most typically utilized by the third department of the Rizzoli Orthopaedic Institute. extensive surgical methods for the surgical operation of bone tumors were excluded as they care for particular «compartmental» equipment which don't contain the anatomic principles to be within the common therapy of orthopaedic and trau­ matologic affections of the extremities.

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Extra resources for Anatomical Exposures and Surgical Approaches to the Limbs Anatomische Darstellungen und Zugangswege in der Chirurgie der Extremitäten

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44 THE MEDIAN NERVE AT THE ARM N. MEDIANUS AM OBERARM I 45 THE HUMERAL ARTERY AND MEDIAN NERVE AT THE ELBOW Guide muscle: biceps tendon. The patient is in supine decubitus; the elbow is extended, the forearm supinated. A 6 cm long incision is extended obliquely downwards and outwards above the flexion crease in the elbow (from the internal bicipital groove as far as the median line of the forearm). - The subcutaneous layer is detached to reveal the median basilic vein 1, which must be fastened, and the lacertus fibrosus 2 , which is dissected for its entire thickness along the internal margin of the biceps tendon.

Die beiden Muskeln werden zur Darstellung der A. radialis 3 und ihrer Begleitvenen nach radial und medial prapariert. Der sensible Ast des N. radialis 4 verlauft weiler radial unter dem M. brachioradialis und zieht iiber dessen Sehne auf die Streckseile zum Handriicken. 64 THE RADIAL ARTERY AT THE MID-DISTAL THIRD OF THE FOREARM A. RADIALIS 1M MITTLEREN UNO OISTALEN UNTERARMORITTEL - 65 THE RADIAL ARTERY AT THE ANATOMICAL SNUFF-BOX The hand and forearm are in pronation. A 5 cm long rectilinear incision is made over the distal epiphysis of the radius along the axis of the first metacarpal bone.

A median longitudinal incision is made beginning a four-finger breadth distal to the flexion crease of the elbow, extending downwards for approximately 20 cm in length. - Beginning at the distal pole of the wound, the fascia is opened up and the interval between the palmaris longus 1 and the palmaris brevis 2 is located: the muscular bellies, which are mostly tendinous, are clearly revealed in this site, thus facilitating dissection. Strongly retracting the flexor carpi radialis 1 upwards and the palmar gracilis 2 downwards, the musculoaponeurotic arch of the flexor digitorum superficialis 3 is revealed below (satellite muscle of the median nerve).

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