Jake is a 25-year-old professional motorbike racer and current Australian champion who sustained a significant left shoulder injury following a high-impact fall during a competitive race. Landing heavily on his left shoulder, he sustained a displaced, four-part fracture of the left clavicle (collarbone).

He was initially assessed at Liverpool Hospital, where conservative management with a sling was recommended. However, he continued to experience considerable pain, swelling and bruising around the injured area.

Assessment and Diagnosis

Clinical examination revealed extensive bruising and a visible deformity of the left clavicle, which appeared shortened and displaced anteriorly. A small abrasion was also noted at the back of the shoulder. Importantly, his neurovascular examination was normal, with no evidence of nerve or vascular compromise.

X-ray imaging confirmed a significantly displaced, four-part fracture of the left midshaft clavicle.

Surgical Treatment

Given the complexity and degree of fracture displacement, together with the patient's professional sporting commitments and desire to return to competitive racing as soon as safely possible, surgical management was recommended.

The Jake underwent open reduction and internal fixation (ORIF) of the left clavicle. During surgery, the four-part fracture was carefully exposed and realigned. The butterfly fragment was reduced and secured with a lag screw, and the fracture was restored to its appropriate length. A 10-hole anatomical clavicle plate was then used to stabilise the fracture, with additional local bone graft to support healing. The remaining butterfly fragment was also secured with cerclage sutures.

Intraoperative imaging confirmed excellent fracture reduction and fixation. The wound was thoroughly irrigated and closed in layers.

Following surgery, he was advised to gradually use his arm as comfort allowed.

The main issue was that the Jake needed to compete 3 weeks later in a major professional motorbike race.

Postoperative Progress

At his one week postoperative review his wound had healed well and the Jake had near full range of motion of his shoulder. At 2 weeks there was no real pain and he had a full range of motion and could do a push up. Xrays looked anatomical. At this stage it was discussed extensively with the Jake about returning to riding and racing with the understanding there was a risk with another high speed fall. He successfully raced at 3 weeks at speeds of close to 300kmh and actually won an event. On top of this in one of his races he did have a fall but the fixation of his clavicle held on and he was able to race the rest of that weekend. This had initially caused some tenderness around the operated clavicle but settled reasonably quickly. Repeat X-rays demonstrated that the surgical fixation remained intact, with the fracture showing good signs of healing and no evidence of fixation failure.

Return to Racing

At his most recent review at 8 weeks post surgery X-rays demonstrated approximately 80% fracture union. Although a faint fracture line remained visible, healing was progressing well.

Clinically, he had made an excellent recovery, regaining full shoulder range of motion and normal strength. He had returned to unrestricted motorbike riding and reported feeling back to normal.

Given his excellent functional recovery and ongoing fracture healing, he was advised to continue with his usual activities and competitive racing. A further review was planned for March, following the conclusion of the Australian racing season, to assess his ongoing recovery. The plate will more than likely remain in forever. The Jake was extremely happy with the result.

Outcome

This case highlights the successful management of a complex, significantly displaced clavicle fracture in a professional athlete. Surgical fixation restored the alignment and stability of the fracture, allowing progressive rehabilitation and a rapid return to competitive motorbike racing with the understanding that there are some risks involved.

It also demonstrates the importance of individualised treatment planning for athletes, balancing the demands of high-level sport with the need for adequate bone healing and restoration of strength and function.