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To analyze differences in sports injury characteristics of the upper and lower extremity and to identify factors that contribute to the risk of sustaining an upper extremity injury compared with the risk of sustaining a lower extremity injury.Retrospective cohort study.An emergency department of a large European level I trauma center.A total of 25 120 patients with a simple sports injury, attending during 1990-2005.Independent variables used to assess risk factors were extracted from a local database. These include age, sex, type of injury, site and side of the injury, type of sport, injury mechanism, and data on admission.Main outcome measure was the relation of various risk factors to the occurrence of either upper or lower extremity injury. Logistic regression analysis was used to identify predictors for upper extremity injury.Thirty-five percent upper and 53% lower extremity injuries were recorded. Most injuries were sustained when playing soccer (36%). Fractures were more frequently diagnosed in the upper than in the lower extremities (44% and 14%, respectively), especially in children. Falling was the main cause of upper extremity injury. Further risk factors were young age and playing individual sports, no-contact sports, or no-ball sports. Women were at risk in speed skating, inline skating, and basketball, whereas men mostly got injured during skiing and snowboarding.A high percentage of sports injuries are sustained to the upper extremity. Different risk factors were identified for both sexes. These risk factors should be taken into account when designing preventive measures.