The slack is then taken up by further twisting. Repeat this until the desired tension is achieved. Both loops must be tightened at the same time and in the same direction, to achieve equal tension on both arms of the wire.
Tighten the screw carefully. Trim the twists and turn both ends towards the tibia in order not to irritate the soft tissues later.
In osteopenic bone care must be taken to avoid excessive tensioning.