Craniofacial Injuries in Combat Sports: Patterns Across Boxing, Wrestling, and Martial Arts

Combat sports, including boxing, wrestling, and martial arts, have surged in popularity across the United States, raising concerns over craniofacial injuries. Despite clinical awareness, large-scale epidemiologic data comparing injury patterns across combat sport disciplines remain limited.

This study utilized data from the National Electronic Injury Surveillance System (NEISS) spanning 2014 to 2023 to assess craniofacial injuries presenting to US emergency departments. Injuries associated with boxing, wrestling, and martial arts were filtered using NEISS product codes specific to the head, face, neck, ear, eye, and mouth. National estimates were calculated, and injury characteristics were stratified by sport, age, sex, injury location, and diagnosis.

An estimated 186,471 craniofacial injuries were reported over the decade, with wrestling accounting for 50.7%, martial arts 29.4%, and boxing 20%. Adolescents aged 10 to 19 experienced over 60% of all injuries, and 87% of patients were male. The most common diagnoses were lacerations (38.5%), concussions/internal head injuries (24.1%), and fractures (10.7%). Boxing exhibited the highest proportion of facial fractures (13.2%), whereas martial arts accounted for the most ocular injuries, with eye trauma comprising 6.3% of cases. Hospital admissions were rare (~2%-3%) but proportionally highest in martial arts (2.8%).

Combat sports pose a substantial risk for craniofacial trauma, particularly among youth participants. Wrestling generated the highest volume of head and neck injuries, challenging assumptions about striking sports being most hazardous. These findings highlight the need for sport-specific injury prevention strategies, protective gear use, and ongoing surveillance to enhance safety in this rapidly growing athletic domain.