Tension band wiring is not effective for which fracture pattern?

• A. Greenstick fractures
• B. Oblique fractures
• C. Transverse fractures
• D. Comminuted fractures

Answer: (D)

Tension band wiring works by converting distracting bending forces into compressive forces at the fracture site. The wire is placed so that when the limb bends, the tension in the wire pulls the fracture fragments toward each other, creating compression across the fracture. This mechanism relies on a simple configuration with two main fragments that can be pressed together along a single plane, which is why it’s most reliable for transverse or short oblique fractures.

In a comminuted fracture, there are multiple small fragments with no single plane of contact to compress. A single tension band cannot effectively secure or compress all the pieces, so the fixation is unstable and reduction is likely to be lost. For these patterns, more robust methods such as plating or other fixation strategies that can stabilize many fragments are preferred.