Return to riding after open reduction internal fixation of acute clavicle fractures in professional horse jockeys

High-velocity, traumatic fracture of the clavicle is one of the most common injuries suffered by professional horse jockeys. Operative fixation represents the mainstay of treatment in this cohort. Despite this, there remains a paucity of evidence to guide post-operative recovery and time to return to riding. Accordingly, the aim of the present study was to establish the safety and efficacy of open reduction internal fixation of acute clavicle fractures in professional horse jockeys. A prospectively maintained database was used to retrospectively identify professional horse jockeys that underwent open reduction internal fixation of an acute clavicle fracture between January 2008 and December 2024. All operations were performed using a limited incision approach to expose, reduce and plate the fracture site. Primary clinical outcomes included the Disabilities of the Arm, Shoulder and Hand (DASH) score, and time to return to riding, full range of motion, and radiographic union. Descriptive statistics were calculated, including means for continuous variables and proportions for categorical variables, and comparative analysis of means was performed using independent samples T-tests. In the 72 professional horse jockeys that underwent open reduction internal fixation for acute clavicle fracture, the mean time to return to riding was 7 weeks (range 5 - 16), with a mean DASH score of 1 (range 0 - 19) at 12 months post-operatively. Mean time to radiographic union was 10 weeks (range 4 - 32), and full range of motion was achieved on average at 7 weeks (range 2 - 32) post-operatively. Significant complications were rare, with patients reporting severe post-operative numbness or plate irritation in 1.4% and 5.6% of cases, respectively. Open reduction internal fixation of acute clavicle fractures in professional horse jockeys is safe and efficacious. Operative management in this patient demographic reveals excellent functional outcomes with infrequent complications, and can facilitate timely return to riding. Level IV: Case Series, Treatment Study.