Competitions in Karate are either carried out as Shobu sanbon (with fist padding) or Shobu Ippon (without fist padding). Aim of this study was to gain current data on injuries in modern competitive Karate and to compare the two different competitive systems. During the WKC-Karate-World-Championships held from June 12-13 1999 at Bochum, 392 bouts were carried out. Every injury that was seen by the tournament doctor was registered. 142 competitors sustained 168 injuries: 141 mostly minor contusions of the head and throat, 12 facial lacerations, 3 knock-outs (mild brain injury), 3 thoracal contusions, 1 midfoot fracture and 9 other blunt injuries. We saw more injuries in Shobu Sanbon (146/302 bouts) than in Shobu Ippon (23/90). Most of the injuries (152) were caused by punches. In Shobu Sanbon, kicking techniques led to 17 injuries only. The injury pattern shown here is comparable to earlier studies. Severe injuries in competitive Karate are rare. The higher number of injuries in Shobu sanbon may be due to the longer fighting time and higher scoring. Fist pads used in Shobu Sanbon might also lead to a loss of control. Therefore, prophylactic fist padding to avoid injuries in competitive Karate has to be seen critically.