Limitations in rotational correction: 3D displacement analysis of midshaft clavicle fractures with titanium elastic nails

To investigate the three-dimensional displacement of midshaft clavicular fractures after closed reduction and fixation with titanium elastic intramedullary nails. From January 2019 to January 2023, 74 patients with midshaft clavicle fractures (classified according to the AO/OTA system as groups A, B, and C) underwent closed reduction and titanium elastic nail fixation. Preoperative bilateral clavicular CT data and postoperative CT data of the affected clavicle were recorded and processed using Mimics software. Clavicle length, clavicle shortening, separation, and rotational displacement along the X/Y/Z axes were measured and recorded. Within-group comparisons showed a significant reduction in clavicle shortening and separation displacements, with a notable restoration of clavicle length postoperatively (p < 0.05). Except for Z-axis rotational displacement in Group A, no significant differences were observed in clavicle rotational displacement along the X/Y/Z axes between preoperative and postoperative measurements (p > 0.05). Between-group comparisons showed that preoperative separation displacement was significantly associated with AO/OTA classification (H = 6.427, p = 0.040), while no significant differences were observed in other displacements between preoperative and postoperative measurements across groups. Titanium elastic intramedullary nails effectively restore clavicular length and correct shortening and separation displacement in midshaft fractures, but do not significantly improve rotational displacement along the X/Y/Z axes.