Thirty-seven consecutive patients with severe snowboard-related injuries (defined by referral to a Level I trauma centre) were reviewed. The type and mechanism of each injury were examined and found to be similar to those reported for skiers. Mild closed head injuries were common (54 per cent). Head and abdominal injuries were more common among snowboarders than skiers, but chest and skeletal injuries were rare. There were no deaths. Serious snowboarding injury rates were similar to those for serious skiing injuries. The incidence of snowboarding injuries sufficiently severe to require tertiary referral was estimated at 0.03 injuries/1000 snowboarder days. Similar to reports of minor snowboarding injury, these data indicate that injury patterns in more serious snowboarding accidents are quite different from those of serious downhill skiing accidents. Injured snowboarders suffer splenic injuries more often and chest and spinal injuries less often than do skiers, and should be evaluated for blunt injuries with these statistical differences in mind.