Gutsy Dutchwoman Annemiek Van Vleuten rode through the pain of a fractured elbow to win a pulsating world cycling road race on Saturday after launching a breathtaking late solo attack.

The 39-year-old Tour de France champion held off a challenge by Belgium's Lotte Kopecky by one second after a gruelling 164.3 kilometre (102 mile) slog in the rain around Wollongong, south of Sydney.

Italy's Silvia Persico took the bronze.

"I think this was the best victory of my whole career with the week I have been through. Miracles can happen," said Van Vleuten, who fractured her elbow in the mixed relay on Wednesday after crashing heavily.

Medics only gave her the green light to challenge for the rainbow jersey on Friday evening.

"It was hell today," she added of the pain. "My legs were exploding on the climbs."

The win capped an incredible season for the Movistar rider, who won the Tour de France, Giro and Vuelta to sweep the women's major tours in 2022, as well as the Liege-Bastogne-Liege to cement her status as an all-time great.

Van Vleuten was pessimistic before the race about being able to attack on the short, sharp climbs because her injury made it too painful to get out of the saddle.

She stayed in touch during a series of breakaways in the final city circuit lap that split the peloton and left her three-time champion teammate Marianne Vos adrift on the last climb, before soaring away in the final kilometre to add to her 2019 title.

"I was working for Marianne and I suddenly found myself in the (leading) group," said Van Vleuten, who is set to retire at the end of next season.

"Then I felt that she wasn't coming back, so I knew that I couldn't sprint with my elbow, and I was waiting for the moment to attack from behind.

"That was the only chance that I had and I was waiting, and waiting until they came with a sprint over the top of me, but they didn't catch me."

Seventy-eight of the 130 riders finished, with the Dutch team weakened by Demi Vollering withdrawing after getting Covid.

Reeled In 

The pack headed south from the start at Helensburgh, hugging the Pacific coast, towards the heart of the championships in Wollongong, before a steep climb up Mount Keira and then six circuits of the city.

In sunshine and showers, France's Gladys Verhulst powered 1mins 20sec clear of the peloton as they approached Mount Keira. But the gap narrowed on the fast and wet descent, and they were bunched again with 118 kilometres to go.

Belgium's Julie Van de Velde, Britain's Elynor Backstedt and Swede Caroline Andersson then attacked to form an elite group with a 90-second gap.

But the strong Italian team took charge to reel in the breakaway riders.

The peloton thinned as fatigue set in, with Italy's defending champion Elisa Balsamo left behind with 26 kilometres left.

A series of attacks in the final lap saw a group of five pull clear before they were hauled in by a chasing group, including Van Vleuten, who timed her final attack to perfection.

The first-ever women's under-23 title was also decided as part of the elite race, with New Zealand's Niamh Fisher-Black taking the honours.

Allrounder Zoe Backstedt, Elynor's sister, celebrated her 18th birthday by defending her junior road-race title with a dominant performance, adding to the individual junior time-trial crown she won this week.