Epidemiology of professional bare-knuckle fighting injuries

Professional bare-knuckle fighting (BKF) is a variation of boxing which held its first modern legal event in 2018 in Wyoming. Since then, the sport has expanded with state-sanctioned events held in Florida, Missouri, Mississippi, Kansas, and Alabama. The purpose of this study was to evaluate the epidemiology of injuries in bare-knuckle fighting bouts and to discern any trends which may distinguish it from traditional boxing with padded gloves.

Observational data collection for all state-sanctioned professional bare-knuckle fighting bouts was conducted sequentially over a two-year period from June of 2018 through November of 2020. Information related to fight outcome, injury diagnosis, and injury location was documented. This data was then analyzed and the incidence rates by injury type and location were calculated.

There were 141 bouts conducted during the study period. Out of the 282 individual combatants, 105 (36.6%) sustained at least one injury during the event and 123 total injuries were recorded. In total, 98 (34.8%) lacerations were recorded; on average, 6.2 +- 4.5 sutures were required per laceration. There were 5 superficial hand lacerations and 80 facial lacerations. Seventeen (6.0%) fractures occurred, with 8 hand fractures, 6 nasal fractures, 2 orbital fractures, and 2 dental fractures. There were 8 (2.8%) periorbital hematomas sustained by fighters. Transfer to the hospital was required on 5 (1.8%) separate occasions, twice for orbital fractures and 3 times for traumatic brain injuries. In all, there were 8 (2.8%) concussions with symptoms.

The most frequent injuries in BKF include lacerations and hand fractures. Concussions are relatively uncommon compared to other injuries.