Patterns of injuries seen in the emergency department (ED) following an ice storm were evaluated and compared to those seen during a control snow period. We conducted a retrospective chart review for an 11-day ice period and an 11-day control snow period using charts from eight metropolitan area EDs. Charts were reviewed for all patients with complaints of falls, motor vehicle crashes (MVCs), or sledding accidents due to ice or snow conditions. The numbers of injuries resulting from falls, MVCs, and sledding accidents for patients of various ages during each of the two periods were compared by chi-square analysis. Of 1,631 patients seen during the 11-day ice period, 1,181 (72%) had injuries due to falls, 192 (12%) were injured in MVCs, and 232 (14%) suffered sledding injuries. Falls on ice resulted in a fracture 39% of the time, whereas MVCs resulted in fracture 14% of the time. Falls accounted for 90% of the fractures during the ice period versus 76% during the snow period. The risk of sustaining a fracture as a result of a fall was significantly higher in older age groups (relative risk [RR]=2.1), as was the risk of hospitalization (RR=2.3). There was a significant increase in the number of falls and sledding accidents during the ice period. Thus, ice coverage resulted in a significant increase in fall-related and sledding-related fractures requiring treatment in the ED.