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Additional info for Small Fragment Set Manual: Technique Recommended by the ASIF Group
23) b Tension-wiring of olecranon and patella: The wire loop must overcome the tensile forces of muscles acting at the fracture line. Flexion of the joint produces compression of the fracture plane. Parallel Kirschner wires neutralize the shearing forces (see Manual of Internal Fixation, 1979, Figs. 25 and 26) c A plate may also act biomechanically as a tension band. The plate is applied on the opposite side to that on which the main tensile forces fall. Interfragmentary compression on the cortex near the plate is augmented by the tension applied to the plate 37 Fig.
The sling may be used for postoperative treatment of the upper limb provided that active elbow and shoulder exercises 52 are executed as mentioned before. In the lower limb a well fitted elastic bandage is mandatory when the patient gets out of bed. After the first attempt at walking. the wound must be checked for swelling and haematoma formation. Active l11obili~atiol1 of the joints is begun immediately after operation , as much as the bandage and the fixa tion will allow. The distal joints must also be moved, if necessary by assisted exercises.
They should bear 10-15 kg weight, never exceeding 20 kg. The injured limb must never be overloaded. The load applied to a leg can be tested on a weighing machine. g. shaking hands or rising up in the bed, are associated with stresses on the fracture . The danger of secondary displacement in internal fixation of the hand and the arm is considerable. Some psychological conditions. such as lack of judgement, obstinacy or laziness, may have undesirable consequences, and therefore individual management of each patient is necessary.