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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 commit a number of years to the writing of this Atlas used to be in line with the pro acknowledgement of detrimental surgical effects as a result of mistaken or incomplete techniques to the bones or joints requiring remedy. we're confident that during order to acquire the very best anatomic and practical leads to surgical procedure of the locomotor gear, it is vital to obey numerous ideas of behaviour con­ stituting the root for proper surgical execution: a) to admire the anatomy of the muscular and neural formations; b) to protect the vascularization of those anatomical parts and hence of the osteoarticular gear; c) to exploit the main acceptable surgical methods totally respecting the nearby anatomy and the least nerve-racking publicity of the skeleton; d) to properly practice surgical procedure, therefore growing 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 now have established our number of the previous on their frequency within the common surgical job of any specialized ward, and the latter at the surgi­ cal ways most typically utilized by the third department of the Rizzoli Orthopaedic Institute. large surgical techniques for the surgical operation of bone tumors were excluded as they take care of particular «compartmental» equipment which don't contain the anatomic ideas to be within the common remedy of orthopaedic and trau­ matologic affections of the extremities.

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Brachialis 3 nach lateral distal. 32 THE MUSCULOCUTANEOUS NERVE AT THE ARM N. \ ; r I I I ' \ I , \ I I , , I , I : I j' ,, ,, ," , : : ''' \ ' : 33 THE ULNAR NERVE AT THE ARM Anatomical site: between the internal intermuscular septum and the triceps. The patient is placed in supine decubitus; the shoulder is abducted (90 degrees), the limb extrarotated, the elbow flexed (70-80 degrees). A longitudinal posterointernal incision is made following an ideal line joining the posterior column of the axilla to the epitrochlea 1.

After the biceps tendon 3 is retracted externally, the humeral artery 4 is revealed, running medially and almost in contact with it; the nerves is located approximately 1 cm more internally, and proceeding downwards it moves away from the artery. A. BRACHIALIS UND N. MEDIANUS AM ELLENBOGEN Leitstruktur: Sehne des M. biceps brachii. Patient in Riickenlage, Ellenbogen gestreckt, Unterarm supiniert. Der ca. 6 cm lange Hautschnitt beginnt am Sulcus bicipitalis medialis und zieht von medial nach lateral iiber die Ellenbeuge nach distal und endet aUf der Mittellinie des Unterarms.

Ulnaris 4 verlauft radial vom N. ulnaris 5 • 1m Guyon-Kanal teilt sich der Nerv in seine Endaste aUf: a) Der Ramus profundus 6 oder motorische Ast zieht zwischen dem M. abductor digiti V und dem M. flexor digiti V brevis in die Tiefe. icia/is 7 gibt einen diinnen Ast 8 zum M. palmaris transversum und teilt sich in zwei Aste, die Kleinfinger und Ringfinger sensibel versorgen. 42 THE ULNAR NERVE AT GUYON'S CANAL N. ULNARIS 1M «GUYON-KANAL» -1' ,;~--- ----""------ ~ 43 THE MEDIAN NERVE AT THE ARM Anatomical site: between the medial intermuscular septum and the biceps.

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