Intraoperative Guidewire Breakage During Open Reduction and Internal Fixation of Pediatric Medical Epicondyle Humerus Fracture: A Single-Institution Review

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. A retrospective cohort study was conducted to identify all pediatric patients with medial epicondyle humerus fracture surgically managed with a cannulated screw. Data collected included patient demographics, guidewire and screw characteristics, tourniquet times, and postoperative complications. 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 = 0.01). All guidewire fragments were left in situ with no documented postoperative complications at 3 months follow-up. Guidewire breakage is an underreported complication of medial epicondyle humerus fracture fixation with cannulated screws warranting increased awareness among the orthopaedic community. III, retrospective cohort study • Guidewire breakage occurred in 6.1% of pediatric medial epicondyle ORIF cases. • Breakage most often followed wire repositioning or over drilling with small threaded wires. • Guidewire breakage increased tourniquet time but caused no short term complications. • Intraosseous wire fragments may be left in situ if motion is unaffected.