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Intraoperative Guidewire Breakage During Open Reduction and Internal Fixation of Pediatric Medial Epicondyle Humerus
Haad A Arif1, Ashleigh N Pyle2, Isabela Lamadrid2
1Department of Orthopaedics, University of Alabama at Birmingham, Birmingham, AL, USA.
Insights
Guidewire breakage occurred in 6.1% of pediatric medial epicondyle humerus fracture surgeries using cannulated screws. This complication, linked to longer tourniquet times, did not result in adverse outcomes.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Surgical Complications
Background:
- Intraoperative complications of medial epicondyle humerus fracture fixation are known.
- The specific frequency and implications of guidewire breakage during this procedure have not been previously detailed.
Purpose of the Study:
- To determine the incidence of guidewire breakage during surgical fixation of pediatric medial epicondyle humerus fractures.
- To identify factors associated with guidewire breakage and its clinical impact.
Main Methods:
- Retrospective cohort study of pediatric patients undergoing surgical fixation for medial epicondyle humerus fractures with cannulated screws.
- Data collection included patient demographics, guidewire/screw characteristics, tourniquet times, and postoperative complications.
Main Results:
- Guidewire breakage occurred in 6.1% of 99 cases.
- Breakage was more frequent with 1.25 mm guidewires and 4.0 mm cannulated screws.
- Guidewire breakage correlated with significantly longer tourniquet times (P = .01).
Conclusions:
- Guidewire breakage is an underreported complication in pediatric medial epicondyle fracture fixation.
- All guidewire fragments were managed in situ without noted postoperative complications at 3 months.
- Awareness and technique modifications, such as limiting repositioning and maintaining co-axial trajectory, are recommended.
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.
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