An estimated 8.2 million occupational injuries occur annually to women in the United States. This case-crossover study of 1166 subjects compares transient risk factors for occupational traumatic hand injury to women and men. Study subjects were recruited over a 3-year period (1997 to 2000) from 23 occupational health clinics in five New England states. The case-crossover design was used to estimate the short-term risk of an acute hand injury while controlling between-person potential confounders. Subjects reported on the occurrence of seven transient exposures within a 90-min period and provided control exposure information during the month before an acute hand injury. A total of 275 women and 891 men were interviewed a median of 1.3 days after injury. Lacerations were the most common injury type in both women (58%) and men (64%). Relative risks for women were higher for being distracted, doing unusual tasks, and working with malfunctioning equipment or materials, and were lower than men for being rushed. Gloves provided significant protection for males and females. Results suggest the importance of considering both the prevalence of various exposures and gender in modifying risk factors to reduce the incidence of acute hand injury in the workplace. Thus, greater emphasis should be placed on the planning of safer working environments for all workers.