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Dominik Szymski,1 Leonard Achenbach,2,3 Martin Siebentritt,4 Karola Simoni,5 Norbert Kuner,5 Christian Pfeifer,1 Werner Krutsch,1,6 Volker Alt,1 Rainer Meffert,2 Kai Fehske2 1Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany; 2Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, University Wuerzburg, Wuerzburg, Germany; 3Department of Orthopaedics, Koenig-Ludwig-Haus, University Wuerzburg, Wuerzburg, Germany; 4Department for Anesthesiology and Operative Intensive Care, Bayreuth, Germany; 5General Medicine and Dermatology, Medical Center for General Medicine, Dermatology, Paediatrics and Internal Medicine, Costa Calma Fuerteventura, Costa Calma, Spain; 6Sports-Orthopedics, SportDocs Franken, Nuremberg, GermanyCorrespondence: Kai FehskeDepartment of Trauma-, Hand-, Plastic- and Reconstructive Surgery, University Wuerzburg, Wuerzburg, GermanyTel +49 931 201 37001Fax +49 931 201 37009Email kai.fehske@ukw.deIntroduction/Background: Surfing, wind surfing and kite surfing enjoy a growing popularity with a large number of athletes worldwide. The aim of this study was to identify and compare the injury profiles and compare the injury profiles of these three extreme water sports.Materials and Methods: These data for this retrospective cohort study were collected through an online standardised questionnaire during the 2017– 18 season. The questionnaire included questions about anthropometry, skill level, injury diagnosis, injury mechanism, environmental conditions and training regimes.Results: The 626 athletes included reported 2584 injuries. On average, each athlete sustained 4.12 injuries during the season. The most frequent injury location was in the lower extremity, in particular the foot, with 49 (16.4%) injuries in surfing, 344 (18.3%) in wind surfing and 79 (19.7%) in kite surfing. Surfing demonstrated a particularly high rate of head injuries (n = 37; 12.4%). Other frequent injury types were skin lesions (up to 42.1%) and contusions (up to 40.5%). The most common injury across all surfing sports was skin lesions of the foot (wind surfing: 11.7%; kite surfing: 13.2%; surfing: 12.7%). In surfing, skin lesions of the head were frequently observed (n = 24; 8.0%). In surfing, a ‘too large wave’ (n = 18; 24.7%) was main cause of the injury, while in wind surfing (n = 189; 34.5%) and kite surfing (n = 65; 36.7%) ‘own incompetence’ led to the most injuries.Conclusion: This unique study compares injury epidemiology and mechanism in the three most popular surfing sports: wind surfing, kite surfing and surfing. Overall, injuries were sustained mainly in the lower extremity, while surfing also demonstrated a high rate of head injuries.Keywords: water sports, injury, training, ankle, foot, epidemiology