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THE entire length of the radius is most easily exposed through an anterolateral incision. ANATOMY.Three long muscles flank the bone upon its outer or lateral border---the brachioradialis, miscalled the supinator longus, and the long and short radial extensors of the wrist (Fig. 324). They can be retracted outwards when they have been relaxed by bending thc elbow. These three muscles have origins FIG. 328. -Anatotoical relationships nt the upper part of the radius. The white crescnnt hetaeen the two black insertions represents the bicipital bursa and shows how it lies in a bay formcd by thn supinntor edge. The surgeon is guided l o the h r s a by thc outer face of the biceps tondon. face of the biceps tendon.which are proximal to the elbow-joint, and in order to mobilize them fully, the incision must extcnd proximal to the elbow. Further, this lateral group of three is strapped t o the lower fourth of the radial shaft by two small muscleswhich form an oblique proniinencc when the hand is prone. When the long muscles are raised from the bone these two short muscles are raised with them. The pronator teres, inserted at the middle of the radial shaft upon its outer face, will then be exposed, and full pronation of the hand will reveal an expanse of bone in the lower half of the shaft.The supinator muscle grasps the upper third of the shaft, and the posterior interosseous nerae (deep branch of the radial-l3.X.A.) penetrates the ariterolateral face of the supinator, and lies between two layers of the muscle : the deep layer separates the nerve from the bone. The supinator attachmcnt to thc radius skirts the edge of thc bicipital tuberosity, which is covered in front by a bursa (Fig. 322).Tht Deep Guide.-The edge of the supinator is obscured by the loose connective tissue that surrounds the recurrent radial vessels, but it can be reached with precision by following the outer The outer face of the tendon leads the surgeon to the bursa : -the knife cuts through this to the tuberosity and a t once affords t,he rugirie a point of direct contact with the bone (Fig. 325). It is * Shown at the Section of Surgery, Royal Academy of Medicine in Ireland. April 3, 1915.

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IT is often well for the surgeon dealing with nerve lesions to have an orthopzdic string to his neurological bow. Especially is this the case in a hospital practice where the almost immediate restitution of function is confidently expected by the patient as a rcsult of operation. Nerve suture in this circumstance, with its tedious interlude and uncertain promise, is not always the chosen procedure, and the following is an example of a short cut to function which I believe has not been previously described.HIsTom.-The patient, a well-developed youth of 17, was referred to me from thc Medical Division of Kasr el Aini Hospital by Dr. Yussef Barrada. He had been operated on elsewhere eighteen months before for enlarged glands in the left sidc of the neck, and he was discharged in a fortnight, as he said himself, "perfectly satisfied". He was in the habit of lifting weights and doing physical exercises, and two months later he felt difficulty in using his left arm. After a few days hc noticed that his shoulder-blade was projecting upwards, and that it was sliding to and fro more freely than he thought it should. He also felt a painful drag on his left shoulder. He then consulted a doctor, and was advised to bandage his arm with the elbow supported. This was done for a short period the q m c R of tho 6th cervical nnd 3rd dorsal vortebrre by two strips of scar of operation at the upper third of the left sternomastoid, with some induration deep to the scar. The point of the left shoulder was depressed, and the medial angle of the scapula projected prominently at the left side of the neck. The whole trapezius muscle was wasted and did not contract. The sternomastoid was paretic. There was slight winging of the left scapula which the patient could correct.

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