Abstract
BACKGROUND: While several intraoperative complications of medial epicondyle humerus fracture fixation have been reported, the frequency and implications of guidewire breakage have not yet been described. METHODS: A retrospective cohort study was conducted to identify all pediatric patients with a medial epicondyle humerus fracture surgically managed with a cannulated screw. Data collected included patient demographics, guidewire and screw characteristics, tourniquet times, and postoperative complications. RESULTS: Between January 2020 and October 2025, 99 cases of operatively managed medial epicondyle humerus fractures were identified within a single level I children's hospital. Six (6.1%) cases were complicated by intraoperative guidewire breakage. Guidewire breakage most commonly occurred when using a 1.25 mm guidewire (n = 5/6, 83.3%) with a 4.0 mm cannulated screw (n = 3/6, 50.0%). Guidewire breakage was associated with significantly longer tourniquet times (P = .01). All guidewire fragments were left in situ with no documented postoperative complications at 3 months follow-up. CONCLUSIONS: Guidewire breakage is an underreported complication of medial epicondyle humerus fracture fixation with cannulated screws, warranting increased awareness among the orthopaedic community. KEY CONCEPTS: (1)Guidewire breakage occurred in 6.1% of patients treated with cannulated screw fixation of a medial epicondyle fracture.(2)All instances of guidewire breakage were using a threaded wire.(3)Limit instances of guidewire repositioning and maintain strict co-axial trajectory during overdrilling. LEVEL OF EVIDENCE: III, Retrospective Cohort Study.