The contribution of animals to injury in urban populations is not well described. We reviewed our trauma admissions for animal-related injury to identify animals involved, risk factors and patterns of injury. Eight thousand nine hundred and fifty-four patients were admitted for trauma during the study period. One hundred and sixty-seven injuries were due to animals (1.9%). Horses were involved in 86% and dogs in 10% of injuries. Most horse riders were injured in falls. Factors associated with increased risk included being young, female and riding for leisure. Body regions most commonly injured were the head and both upper and lower extremities. Patterns of injury were identified. Horse-related injury is a significant source of traumatic injury in an identifiable at-risk subgroup of our urban population. High rates of head injury and low rates of helmet use suggest a more effective strategy to encourage use of protective headgear is needed. Further efforts aimed at injury prevention must include an improvement in skill and knowledge of horsemanship, particularly in the at-risk group of young female amateur riders. Mechanistic patterns of injury and body-region markers identified in this study may assist early recognition of severe and occult injuries in these patients.