Background Handball is a contact sport with a high prevalence of acute injuries. Injuries often occur during high-speed movements involving several players, making it difficult to describe the exact mechanism of injury.

Objective Describe the mechanisms of injury in elite male handball.

Design Prospective video analysis.

Setting During the men´s handball world championship 2015, 132 injuries were reported through on-site injury surveillance by team medical staff. Based on the injury reports, two operators accessed the videos of each game and identified the specific injury situations using video analysis software (ProzoneHANDBALL v.1.0.0.14, ProzoneSports, Leeds, UK).

Video analysis A total of 97 injury videos were identified; 42 were excluded, as the injury situation was not visible. Five handball experts performed an individual analysis of the 55 included videos based on a specific form developed to describe the injury situations and causes, followed by a consensus meeting.

Main Outcome Measurements The form included variables related to the playing situation, landing situation, action of attacker and defender at time of injury and localization of tackle/hit.

Results The most common injury location was the head and face (n=17, 31%), followed by the ankle (n=6, 11%). The most frequent injury cause was opponent contact (n=27, 49%), followed by landing trauma subsequent to opponent contact (n=8, 15%). The injuries were equally distributed between attackers (n=29, 53%) and defenders (n=26, 47%), but time-loss injuries (49%) were more common among attackers (68%). The most frequent playing action performed by injured attackers was a jump shot (n=9, 31%); tackles were most often to their throwing arm (n=7, 30%).

Conclusions Acute injuries in elite male handball are equally distributed between attackers and defenders. However, attackers sustain more severe injuries. The most frequent injury causes are direct opponent contact and landing trauma after opponent contact.