Delayed displacement of minimally displaced clavicle fractures in polytrauma patients: a retrospective cohort study

Objective: This study aimed to investigate the incidence and potential predictors of delayed displacement in minimally displaced clavicle fractures associated with polytrauma. It was hypothesized that polytrauma-related factors may reduce the risk of delayed displacement by limiting early patient mobilization.

Methods: Between 2018 and 2021, a cohort study was conducted on 79 patients with minimally displaced clavicle fractures who had an injury severity score (ISS) of 16 or greater and were initially treated conservatively. The patients underwent regular radiographic examinations and those who exhibited displacement of more than 100% during follow-up were classified as having delayed displacement and subsequently underwent surgical intervention. Univariate and multivariate logistic regression analyses were used for statistical analysis to evaluate the risk factors for delayed displacement. The factors included polytrauma-related factors, such as the ISS, accompanying upper extremity injury, scapular fracture, rib fracture, level of consciousness, traumatic central nervous system injury, intensive care unit admission, use of a ventilator, duration of intubation, and fracture-specific factors, which were the location of the fracture and the presence of comminution.

Results: Overall, 31 patients (39.2%) had delayed displacement. The univariate and multivariate logistic regression analyses showed that the statistically significant risk factors for delayed displacement of clavicle fractures were the presence of comminuted fractures and fractures located in the middle third of the clavicle shaft (odds ratio = 5.954 and 4.423, respectively; P = .003 and .018, respectively), while polytrauma-related factors were not associated.

Conclusion: Polytrauma-related factors were not significantly associated with delayed displacement in minimally displaced clavicle fractures accompanied by polytrauma. Instead, fracture-specific characteristics, such as midshaft location and comminution, emerged as important predictors of delayed displacement, even when the initial displacement was minimal. These findings highlight the need for regular radiographic monitoring for at least 5 weeks in patients with polytrauma, particularly when such fracture characteristics are present.

Cite this article as: Lee D, Han K, Park YU, Cho W, Koh J, Choi W. Delayed displacement of minimally displaced clavicle fractures in polytrauma patients: a retrospective cohort study. Acta Orthop Traumatol Turc., 2026; 60(3), 0511, doi: 10.5152/j.aott.2026.25511.