Popular trend sports are characterized by intensive and high speed performance. Due to the high energy mechanism in falls, typical injury distributions and patterns result. In a retrospective study the injury patterns and frequencies in mountain bike athletes were analyzed and pathophysiological, diagnostic and therapeutic options in the treatment of high energy injuries to the carpal bones are shown. Based on a retrospective survey over 2 successive years, active mountain bike athletes (World Cup Series) were interviewed using a standardized questionnaire. Injury patterns and frequencies were analyzed. The pathophysiology, diagnostics and therapy of high energy carpal injuries are discussed. In this study 107 World Cup mountain bike athletes were enrolled. Injuries of the extremities were found in more than 75 % of athletes with a higher prevalence in the upper extremities (40.7 %) than the lower extremities (34.84 %), followed by injuries of the head and face (13.3 %, of which 10.6 % were traumatic brain injuries) and the trunk (10.6 %). Fractures and dislocations of the hand and wrist were found in approximately half of the athletes (50.9 %). In popular trend sports injuries of the extremities are common, especially of the carpal bones and ligaments. It is important to distinguish stable from destabilizing injuries in order to provide adequate therapeutic options.