Tension Band Wiring — MCQs
Following a femoral shaft fracture, your consultant asks you to provide tibia traction. Which of the following will you request from the nurse? 1. Thomas splint 2. K-wire 3. Steinmann pin 4. Denham's pin 5. Bohler's stirrup 6. Bohler Braun splint
Tension band wiring is done in all except -
Displaced transverse patella; what is the treatment?
Tension band wiring is indicated in fracture of which of the following ?
Open reduction (OR) is not required in which fracture?
The compression fracture is commonest in
Agnes hunt traction is used for which of the following conditions?
A cyst is 'deroofed' and the surrounding periosteum is sutured to the margins of the cyst wall. What is this procedure called?
Who is considered the father of distraction osteogenesis?
Triple arthrodesis involves which of the following joint combinations?
Tension Band Wiring Indian Medical PG Practice Questions and MCQs
Question 1: Following a femoral shaft fracture, your consultant asks you to provide tibia traction. Which of the following will you request from the nurse? 1. Thomas splint 2. K-wire 3. Steinmann pin 4. Denham's pin 5. Bohler's stirrup 6. Bohler Braun splint
- A. $1,2,3,4,5,6$
- B. $3,5,6$ (Correct Answer)
- C. $3,4,5$
- D. $1,2,4$
Explanation: ***3,5,6*** - For **tibia traction** in a femoral shaft fracture, you would need a **Steinmann pin** for skeletal traction, a **Bohler's stirrup** to apply the traction force, and a **Bohler-Braun splint** to support the limb. - The **Steinmann pin** is inserted into the proximal tibia, the **Bohler's stirrup** attaches to the pin, and the **Bohler-Braun splint** provides a fixed structure for the traction system. *1,2,3,4,5,6* - This option incorrectly includes items not specifically used for applying **tibia traction** (e.g., K-wire is for internal fixation, Thomas splint is for early femur fracture management but not specifically for tibia traction application). - While some components might be used in general fracture management, not all are directly involved in setting up tibia traction as requested. *3,4,5* - This option correctly includes the **Steinmann pin** and **Bohler's stirrup** but incorrectly replaces the **Bohler-Braun splint** with a **Denham's pin**. - A **Denham's pin** is an alternative to a Steinmann pin for skeletal traction, but a **Bohler-Braun splint** is crucial for supporting the limb in this setup, which is missing here. *1,2,4* - This option includes a **Thomas splint** (used for femur fracture support, not tibia traction application), a **K-wire** (used for internal fixation, not traction), and a **Denham's pin** (an alternative to Steinmann pin, but lacks the necessary support and traction application equipment). - These items are not suitable for setting up comprehensive **tibia traction** for a femoral shaft fracture.
Question 2: Tension band wiring is done in all except -
- A. Fracture olecranon
- B. Fracture medial malleolus
- C. Colle's fracture (Correct Answer)
- D. Fracture patella
Explanation: ***Colle's fracture*** - **Tension band wiring** is generally not the primary treatment for **Colle's fracture**, which is a fracture of the distal radius. - Management often involves **closed reduction and casting** or **open reduction and internal fixation** with plates and screws, rather than tension bands. *Fracture olecranon* - **Tension band wiring** is a common and effective technique for **olecranon fractures**, especially in displaced, comminuted, or transverse fractures. - It converts **distracting forces** into compressive forces at the fracture site, promoting healing. *Fracture medial malleolus* - **Tension band wiring** can be used for selected **medial malleolus fractures**, particularly those that are **oblique** or **vertical** and amenable to compression. - This technique helps to stabilize the fracture by converting tension forces into compression. *Fracture patella* - **Tension band wiring** is a widely accepted and highly effective method for treating **transverse patellar fractures**. - It neutralizes the **distracting forces** of the quadriceps muscle, promoting stable fixation and early mobilization.
Question 3: Displaced transverse patella; what is the treatment?
- A. POP cast
- B. Non operative
- C. Patellectomy
- D. Tension band wiring (Correct Answer)
Explanation: ***Tension band wiring*** - This is the standard treatment for **displaced patellar fractures**, especially transverse ones, as it converts distractive forces into compressive ones, promoting healing. - It involves using K-wires and a cerclage wire to achieve **stable fixation** and allow for early range of motion. *POP cast* - A **Plaster of Paris (POP) cast** is typically used for non-displaced or minimally displaced fractures that do not require surgical stabilization. - It would not provide adequate stability for a **displaced transverse patella fracture**, which is prone to further displacement due to quadriceps pull. *Non-operative* - **Non-operative treatment** is reserved for **non-displaced** or minimally displaced patellar fractures where the extensor mechanism remains intact. - A **displaced transverse patella fracture** disrupts the extensor mechanism, making non-operative treatment unsuitable as it would lead to poor functional outcomes and a high risk of nonunion. *Patellectomy* - **Patellectomy** (partial or total removal of the patella) is considered for severely comminuted fractures where reconstruction is not possible or for chronic symptomatic nonunion. - It is generally avoided as a primary treatment for displaced transverse fractures due to the importance of the patella in **knee extension mechanics** and the risk of quadriceps weakness.
Question 4: Tension band wiring is indicated in fracture of which of the following ?
- A. Fracture spine
- B. Fracture humerus
- C. Fracture tibia
- D. Olecranon (Correct Answer)
Explanation: ***Olecranon fracture*** - **Tension band wiring** is a widely used and effective technique for fixing olecranon fractures, converting tensile forces into compressive forces at the fracture site. - This method is suitable because the olecranon is subjected to significant **distracting forces** from the triceps muscle, and the tension band neutralizes these forces. *Fracture spine* - Spinal fractures generally require **fusion, laminectomy**, or other stabilization techniques depending on the fracture type and stability, not tension band wiring. - The biomechanics and forces acting on the spine are different, making tension band wiring inapplicable. *Fracture humerus* - Humerus fractures, depending on their location (proximal, shaft, distal), are typically managed with **plates and screws**, intramedullary nails, or external fixation. - Tension band wiring is not a primary method for most humeral fractures. *Fracture tibia* - Tibial fractures are commonly treated with **intramedullary nailing**, plates and screws, or external fixation, depending on the fracture pattern and soft tissue involvement. - Tension band wiring is not indicated for the long bone shaft fractures like tibia.
Question 5: Open reduction (OR) is not required in which fracture?
- A. Fracture of the patella
- B. Fracture of the outer one-third of the radius (Correct Answer)
- C. Displaced fracture of the olecranon
- D. Fracture of the condyle of the humerus
Explanation: ***Fracture of the outer one-third of the radius*** - Fractures of the **outer one-third of the radius** (distal radius fractures) often can be managed with **closed reduction and casting** if stable and adequately reduced. - While some unstable distal radius fractures require OR, many stable patterns, especially those with minimal displacement or good alignment after closed manipulation, do not. *Fracture of the patella* - Many patellar fractures lead to significant **extensor mechanism disruption**, necessitating OR with **tension band wiring** or screw fixation to restore quadriceps function. - Displaced patellar fractures, especially transverse ones, require surgical fixation to prevent extensor lag and **nonunion**. *Displaced fracture of the olecranon* - Displaced olecranon fractures disrupt the **triceps mechanism** and compromise elbow stability, almost always requiring **open reduction and internal fixation (ORIF)**, typically with tension band wiring. - Without surgical repair, a displaced olecranon fracture can lead to significant loss of extension strength and **nonunion**. *Fracture of the condyle of the humerus* - Fractures of the humeral condyle, particularly in children, often require OR due to the risk of **avascular necrosis** (especially lateral condyle) and the need for **precise anatomical reduction** to prevent joint incongruity and cubitus varus/valgus deformities. - Intra-articular and displaced condylar fractures almost invariably require surgical intervention to ensure harmonious joint function and prevent long-term complications like **stiffness and deformity**.
Question 6: The compression fracture is commonest in
- A. Upper thoracic spine
- B. Cervical spine
- C. Lumbosacral region
- D. Lower thoracic spine (Correct Answer)
Explanation: ***Lower thoracic spine*** - The **thoracolumbar junction (T11-L2)** is the most common site for compression fractures due to its high biomechanical stress, transitioning from stiff thoracic spine to more flexible lumbar spine. - This area is particularly vulnerable to axial loading and flexion injuries because it's a zone of increased mobility and stress concentration. *Upper thoracic spine* - The upper thoracic spine has **rib cage support** and less mobility, making fractures here less common without significant traumatic force. - Fractures in this region often indicate a **high-energy injury** due to its inherent stability. *Cervical spine* - While cervical fractures can be serious, they typically result from **high-energy trauma** and are less commonly simple compression fractures compared to the thoracolumbar region. - The **cervical spine** is more prone to **burst fractures** or **dislocations** from flexion-distraction or extension injuries. *Lumbosacral region* - The **sacrum and coccyx** are relatively stable bone structures and are less prone to common compression fractures unless there is severe trauma or significant bone weakening (e.g., severe osteoporosis). - While lumbar compression fractures do occur, the **junctional region** between the thoracic and lumbar spine (lower thoracic/upper lumbar) is statistically more frequent.
Question 7: Agnes hunt traction is used for which of the following conditions?
- A. Flexion deformity of the hip (Correct Answer)
- B. Trochanteric fracture
- C. Fracture of the shaft of the humerus
- D. Low backache
Explanation: **Explanation:** **Agnes Hunt Traction** is a specialized form of traction used specifically for the correction of **Flexion Deformity of the Hip**. The underlying medical concept involves applying traction to the affected limb while the contralateral (normal) limb is immobilized in a plaster cast in a position of maximum flexion. This stabilizes the pelvis and prevents compensatory lumbar lordosis, allowing the traction to act directly on the hip joint to gradually stretch the flexor contractures. **Analysis of Options:** * **A. Flexion deformity of the hip (Correct):** It is the classic indication. By neutralizing pelvic tilt, it effectively reduces fixed flexion deformities (FFD). * **B. Trochanteric fracture:** These are typically managed with skeletal traction (like Hamilton Russell traction) or, more commonly, surgical fixation (DHS or PFN). * **C. Fracture shaft of humerus:** This is managed using a U-slab, hanging cast, or skin traction like **Dunlop’s traction** (though Dunlop's is primarily for supracondylar fractures). * **D. Low backache:** This is usually managed with **Pelvic traction**, which helps in relieving muscle spasms and distracting the neural foramina. **High-Yield Clinical Pearls for NEET-PG:** * **Thomas Splint:** Used for immobilization of fractures of the shaft of the femur. * **Bryant’s Traction (Gallows):** Used for femur fractures in children below 2 years of age (weight <15-18kg). * **Russell’s Traction:** Used for trochanteric and subtrochanteric fractures; it uses a sling under the knee. * **Buck’s Traction:** A simple skin traction used for temporary immobilization of hip fractures or to reduce muscle spasms. * **90-90 Traction:** Commonly used in pediatric femoral shaft fractures to maintain the hip and knee at 90 degrees of flexion.
Question 8: A cyst is 'deroofed' and the surrounding periosteum is sutured to the margins of the cyst wall. What is this procedure called?
- A. Decortication
- B. Marsupialisation (Correct Answer)
- C. Saucerization
- D. Enucleation
Explanation: **Explanation:** The procedure described is **Marsupialisation**. This technique involves opening the cyst (deroofing), evacuating its contents, and suturing the edges of the remaining cyst wall to the adjacent soft tissue or periosteum. This creates a permanent "pouch" or window, allowing the cavity to remain open to the exterior and heal by secondary intention. It is typically used for large cysts where complete removal (enucleation) might risk damaging vital structures or causing a pathological fracture. **Analysis of Options:** * **Decortication:** This involves the removal of the outer shell or "cortex" of a bone. In orthopaedics, it is often performed in cases of chronic osteomyelitis or non-union to improve vascularity and promote healing. * **Saucerization:** This is the surgical excavation of a bone cavity (usually in chronic osteomyelitis) to create a shallow, saucer-like depression. Unlike marsupialisation, it involves removing the overlying bone to allow the wound to heal from the base upwards, but it does not involve suturing the cyst wall to the periosteum. * **Enucleation:** This refers to the complete removal of a cyst in its entirety (shelling it out) without rupture. It is the treatment of choice for smaller, well-defined cystic lesions. **High-Yield Facts for NEET-PG:** * **Marsupialisation** is most commonly associated with the treatment of **Odontogenic Keratocysts (OKC)** in the jaw or large unicameral bone cysts. * **Brodie’s Abscess:** The surgical treatment of choice for this chronic localized bone abscess is **Saucerization** and curettage. * **Orr’s Technique:** A classic treatment for chronic osteomyelitis involving debridement, saucerization, and packing the wound open.
Question 9: Who is considered the father of distraction osteogenesis?
- A. Codivilla
- B. Snyder
- C. Ilizarov (Correct Answer)
- D. Alexander
Explanation: **Explanation:** **Gavriil Abramovich Ilizarov** is universally recognized as the **Father of Distraction Osteogenesis**. He pioneered the "Tension-Stress Effect," which describes how slow, steady traction on living tissues creates a metabolic stimulus that activates both proliferative and biosynthetic functions. This biological principle allows for the formation of new bone (callus) between two vascularized bone surfaces that are gradually pulled apart. Ilizarov developed the **Circular External Fixator** (Ilizarov Apparatus) to treat complex fractures, non-unions, and limb-length discrepancies. **Analysis of Incorrect Options:** * **Codivilla (A):** Alessandro Codivilla was the first to report a surgical technique for femoral lengthening in 1905. While he was a pioneer, his methods lacked the biological stability and gradual distraction principles perfected by Ilizarov. * **Snyder (B):** Snyder is associated with early experimental work in distraction, but he did not establish the clinical framework or the biological laws governing the process. * **Alexander (C):** Not a significant figure in the history of distraction osteogenesis; likely included as a distractor. **High-Yield Clinical Pearls for NEET-PG:** * **The Ilizarov Principle:** Distraction is typically performed at a rate of **1 mm per day**, divided into four increments (0.25 mm every 6 hours) to minimize soft tissue trauma and optimize osteogenesis. * **Latency Period:** The time between corticotomy and the start of distraction (usually **5–7 days**). * **Consolidation Phase:** The period where the newly formed bone (regenerate) matures and mineralizes; it usually takes twice as long as the distraction phase. * **Corticotomy:** Ilizarov emphasized a "low-energy" corticotomy to preserve the endosteal and periosteal blood supply, which is crucial for bone formation.
Question 10: Triple arthrodesis involves which of the following joint combinations?
- A. Calcaneocuboid, talonavicular, and talocalcaneal (Correct Answer)
- B. Tibiotalar, calcaneocuboid, and talonavicular
- C. Ankle joint, calcaneocuboid, and talonavicular
- D. None of the above
Explanation: **Explanation:** Triple arthrodesis is a surgical procedure aimed at stabilizing the hindfoot, correcting deformities, and relieving pain caused by arthritis or neuromuscular instability. The term "triple" refers to the fusion of the three primary joints of the hindfoot complex. **1. Why Option A is Correct:** The procedure involves the fusion of the following three joints: * **Talocalcaneal (Subtalar) joint:** Provides inversion and eversion. * **Talonavicular joint:** Part of the transverse tarsal joint; crucial for midfoot stability. * **Calcaneocuboid joint:** The lateral component of the transverse tarsal joint. By fusing these three joints, the hindfoot is locked into a neutral position, providing a stable base for weight-bearing. **2. Why Other Options are Incorrect:** * **Options B and C:** Both include the **Tibiotalar (Ankle) joint**. Triple arthrodesis specifically targets the hindfoot joints *below* the ankle. Fusing the ankle joint along with the hindfoot joints is termed a "pantalar arthrodesis," not a triple arthrodesis. The ankle joint must remain mobile in a standard triple arthrodesis to allow for dorsiflexion and plantarflexion. **Clinical Pearls for NEET-PG:** * **Indications:** Commonly used for Rigid Flatfoot (Pes Planus), Clubfoot (Talipes Equinovarus) deformities in older children/adults, and Rheumatoid Arthritis. * **Goal:** To provide a stable, plantigrade, and pain-free foot. * **Sequence of Fusion:** During surgery, the **Talonavicular joint** is considered the "key" to the reduction and is usually addressed first to set the alignment. * **Contraindication:** It is generally avoided in children under 10–12 years of age to prevent significant foot shortening due to interference with bone growth.
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