Bouldering-related trauma: Injury patterns and operative burden over 10 years at a UK major trauma centre

Bouldering is a rapidly growing discipline within climbing, characterised by short ascents performed without ropes, typically at heights of up to several metres above protective crash mats. While overall injury burden among climbers has been described in the literature, detailed analyses of severe orthopaedic trauma presenting to major trauma centres remain limited. As participation continues to increase, particularly within indoor climbing facilities, a clearer understanding of injury patterns associated with bouldering is needed. This study aimed to characterise the anatomical distribution, injury patterns, and operative burden of bouldering-related trauma presenting to a UK Level I trauma centre.

A retrospective cohort study was conducted of adult patients (≥16 years) presenting with climbing-related orthopaedic injuries between January 2015 and May 2025. Cases were identified through trauma registry and electronic record review. Demographic data, injury mechanism, anatomical injury location, and management strategy were collected. The primary outcome was requirement for operative intervention. Secondary outcomes included injury distribution and specific fracture or dislocation patterns.

A total of 176 patients were identified (mean age 29 years; 51% male). The average reported fall height was 2.9 m. Lower limb injuries predominated, accounting for 62% of all injuries, with ankle fractures representing the most common diagnosis (40%). Upper limb injuries comprised 32%, most frequently radial head fractures (7%) and elbow dislocations (6%). Overall, 24% of patients required operative management. Open injuries were identified in 4% of cases. Lower limb injuries accounted for most operative cases, with ankle ORIF representing 41% of all procedures performed. Upper limb injuries were less frequently managed surgically (19% operative rate) and were typically associated with high impact fall mechanisms.

Bouldering-related injuries presenting to a major trauma centre demonstrate a distinct pattern of acute orthopaedic trauma, characterised by a predominance of lower limb fractures and a relatively high operative requirement for a niche sporting population. These findings differ from traditional climbing literature and highlight the need for targeted injury prevention strategies and climber education.