A 3-year chart survey and questionnaire was conducted of equestrian-injured patients at a regional trauma center to determine patterns and consequences of injury and rate of recidivism. Ninety-two patients (95 encounters) were treated; most were young (mean age, 27 +/- 11 years) women (84%) riders sustaining falls (80%). Most injuries were orthopedic (47%); 19 per cent of patients required hospital admission. There was one death. Helmet use was documented in only 34 per cent. Eighty-one per cent of patients responded to a follow-up telephone survey; 36 per cent recounted additional accidents (mean, 1.4 +/- 0.5). Mean time lost from work was 3 weeks, with 19 per cent reporting chronic disability. Mean annual hospital charges for the cohort were $88,925.00. Recidivism is common in equestrian trauma. Hospital charges are significant. Lost time from work is considerable, with one in five patients reporting long-term disability. Given the cost and disability incurred with equestrian trauma, efforts at injury prevention appear warranted.