Introduction: Horse racing is a hazardous sport. We analyzed the incidence and characteristics of jockey injuries in a typical horse race. Methods: We analyzed all injuries sustained by 224 jockeys in the last 72 years. Results: It was found that in 96.1% of the races there was at least one fall and in 28.6% of the races 50% or more of the jockeys fell. In 43.4% of the falls, the jockey was taken to the emergency room. Comparing the Palio with traditional races in other countries, a higher injury incidence rate was observed for every 100 falls (109.884 vs 27–59) and a lower concussion rate/100 falls (0.97 vs 1.8-7.4). Conclusion: The Palio is one of the most threatening races that continues today. Jockeys are at greater risk for a fall than any other race in the world.
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