Ice hockey is considered to be one of the fastest and roughest of all sports. Prospective injury reports of the North American National Hockey League, the Canadian Amateur Hockey Association and of several European teams (UdSSR, CSSR, Sweden and Switzerland) are reviewed to evaluate the patterns, anatomic locations, circumstances and sequelae of ice hockey-related injuries. Although different injury reporting systems are used in North America and Europe, knee injuries (sprains of the collateral ligaments) accounted for the majority of games missed (40%), followed by injuries to the shoulder (dislocation, acromio-clavicular joint separation, rotator cuff strain and tears, 20%), the groin (15%), and the back (10%). Mandatory helmets and face masks reduced the number of facial and eye injuries to a quarter from 1972 to 1983. The frequency of only concussion but also cervical spine lesions is increasing. The prevention of head, face, eye and neck injuries should mainly be accomplished by enforcement of current rules (mandatory helmets with face masks) and institution of new rules. Improvement in protective equipment would also have the effect of decreasing the frequency of injuries. Ice hockey is the fastest team sport and involves both finesse and controlled aggression. It is also considered to be one of the roughest of all sports. In recent years, ice hockey has grown tremendously in popularity, not only in the United States and in Canada but also in many European countries [1]. The number of both professional and amateur hockey players has increased with the expanding interest in the sport around the world [1].(ABSTRACT TRUNCATED AT 250 WORDS)