Study – Wrestling Presents Highter Facial Injury Rate Than Boxing and Martial Arts

In my ongoing efforts to document scientific studies addressing safety issues in combat sports, a recent article was published examining the facial injury rate among boxing, wrestling and martial arts competitors.

The article, titled “Adding Insult to Injury – A National Analysis of Combat Sports-Related Facial Injury” was published this month in the Annals of Otology, Rhinology and Laryngology.  

The authors reviewed the National Electronic Injury Surveillance System (NEISS) for facial injuries from wrestling, boxing, and martial arts leading to emergency room visits from 2008 to 2013.  Perhaps somewhat counter-intuitively, the study found that wrestling, a combative sport without striking, led to the highest rate of facial injury requiring ER visits with an injury rate of 120 injuries per 100 000 participants with boxing and martial arts competitors suffering facial injuries at a rate of less than half of wrestlers.

The full abstract reads as follows:


Objectives/Hypothesis: To estimate the incidence of patients presenting to emergency departments (EDs) for facial trauma sustained from participation in combat sports and evaluate injury patterns and patient demographics.

Methods: The National Electronic Injury Surveillance System (NEISS) was evaluated for facial injuries from wrestling, boxing, and martial arts leading to ED visits from 2008 to 2013. Relevant entries were examined for injury mechanism, location, type, as well as other patient characteristics.

Results: There were 1143 entries extrapolating to an estimated 42 395 ED visits from 2008 to 2013. Injury rates for boxing, marital arts, and wrestling were, respectively, 44, 56, and 120 injuries per 100 000 participants. Males comprised the majority (93.7%). A plurality of injuries involved lacerations (46.0%), followed by fractures (26.2%) and contusions/abrasions (19.3%). The proportion of fractures was highest among boxers (36.9%). Overall, the most common mechanisms of injury were punching, kicking, and head butting.

Conclusions: The significant number of ED visits resulted from combat sports facial trauma, reinforcing the importance of familiarity with injury patterns among practitioners managing facial trauma. As most injuries involve individuals younger than 19 despite guidelines suggesting children and adolescents avoid combat sports, these findings may be used for patient education and encouragement of the use of personal protective equipment. Furthermore, injury patterns reported in this analysis may serve as an adjunct for enhancing clinical history taking and physical examination.

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