{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T09:12:45Z","timestamp":1790154765457,"version":"4.0.1"},"reference-count":60,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Wild boar-related trauma is uncommon but may result in severe injuries that pose diagnostic and therapeutic challenges, particularly in wilderness or resource-limited environments. Most scientific literature consists of isolated case reports, regional series, and forensic descriptions; clinical guidance is therefore fragmented. This study synthesizes two complementary evidence sources: a structured observational cohort documenting 101 injuries sustained by boar hunters during organized hunts in Germany, and a comprehensive systematic review of all globally published wild boar- and feral pig-related human injuries. The observational cohort provided internally consistent epidemiologic information on who was injured, under what circumstances, how quickly assistance was obtained, and how injuries were treated and ultimately healed. The systematic review added detailed insight into injury morphology and severity across diverse settings, including reports of deep wound tracts, extensive soft-tissue disruption, significant contamination, and the risk of hemorrhage, neurovascular compromise, or thoracoabdominal penetration. The systematic review was conducted in accordance with PRISMA 2020 principles and included explicit study identification, screening, and eligibility assessment. Integrating these sources enabled a field-oriented approach to assessment and management, emphasizing early hemorrhage control, broad-spectrum antibiotic therapy, appropriate use of imaging, thorough surgical exploration when indicated, and region-specific tetanus or rabies prophylaxis. Together, these findings support clinicians working in remote or austere environments who may encounter these rare but potentially serious injuries.<\/jats:p>","DOI":"10.3390\/jcm15197381","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T08:14:39Z","timestamp":1790151279000},"page":"7381","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Wild Boar-Related Injuries in Wilderness Environments: Field-Oriented Management Principles and Evidence-Informed Clinical Recommendations"],"prefix":"10.3390","volume":"15","author":[{"given":"Markus","family":"Maier","sequence":"first","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, Starnberg Orthopedics Clinic, 82319 Starnberg, Germany"},{"name":"Department of Orthopaedics and Trauma Surgery, LMU University Hospital, Ludwig-Maximilians-University of Munich, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2184-7339","authenticated-orcid":false,"given":"Leonard P. N.","family":"Maier","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Trauma Surgery, Klinikum Nordfriesland, 25813 Husum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5668-8831","authenticated-orcid":false,"given":"Simon","family":"Hackl","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, BG Unfallklinik Murnau, 82418 Murnau, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4065-1241","authenticated-orcid":false,"given":"Christoph","family":"Schmitz","sequence":"additional","affiliation":[{"name":"Chair of Neuroanatomy, Institute of Anatomy, Faculty of Medicine, LMU Munich, 80336 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5327-3702","authenticated-orcid":false,"given":"Nicola","family":"Maffulli","sequence":"additional","affiliation":[{"name":"Department of Trauma and Orthopaedic Surgery, Faculty of Medicine and Psychology, University La Sapienza, 00189 Roma, Italy"},{"name":"School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Stoke on Trent ST5 5BG, UK"},{"name":"Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London E1 4NS, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1002\/ps.3965","article-title":"Wild boar populations up, numbers of hunters down? A review of trends and implications for Europe","volume":"71","author":"Massei","year":"2015","journal-title":"Pest Manag. Sci."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Kamieniarz, R., Jankowiak, \u0141., Fratczak, M., Panek, M., Wojtczak, J., and Tryjanowski, P. (2020). The relationship between hunting methods and the sex, age and body mass of wild boar Sus scrofa. Animals, 10.","DOI":"10.3390\/ani10122345"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1007\/s13280-023-01852-1","article-title":"Meeting the challenges of wild boar hunting in a modern society: The case of France","volume":"52","author":"Vajas","year":"2023","journal-title":"Ambio"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2595","DOI":"10.1007\/s00068-024-02654-0","article-title":"Characterization and treatment protocol of injuries inflicted to humans by synurbic European wild boars (Sus scrofa)","volume":"50","author":"Pujol","year":"2024","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_5","unstructured":"Armstrong, J.B., and Gallagher, G.R. (2013). Wild pig attacks on humans. Proceedings of the 15th Wildlife Damage Management Conference, Clemson, SC, USA, 25\u201328 March 2013, Clemson University."},{"key":"ref_6","first-page":"3","article-title":"Human fatalities resulting from wild pig attacks worldwide: 2000\u20132019","volume":"17","author":"Mayer","year":"2023","journal-title":"Hum. Wildl. Interact."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1111\/1556-4029.13994","article-title":"The forensic pathology of fatal attacks by the large mammals inhabiting the nordic wilderness-a literature review","volume":"64","author":"Gudmannsson","year":"2019","journal-title":"J. Forensic Sci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1111\/j.1556-4029.2011.01921.x","article-title":"Animal-related fatalities\u2014Part I: Characteristic autopsy findings and variable causes of death associated with blunt and sharp trauma","volume":"57","author":"Bury","year":"2012","journal-title":"J. Forensic Sci."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/j.emc.2004.01.008","article-title":"North American wild mammalian injuries","volume":"22","author":"Freer","year":"2004","journal-title":"Emerg. Med. Clin. N. Am."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1111\/j.1556-4029.2011.01932.x","article-title":"Animal-related fatalities--part II: Characteristic autopsy findings and variable causes of death associated with envenomation, poisoning, anaphylaxis, asphyxiation, and sepsis","volume":"57","author":"Bury","year":"2012","journal-title":"J. Forensic Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1007\/s00113-021-01073-9","article-title":"Explosionstrauma Teil 1: Physikalische Grundlagen und Pathophysiologie [Explosion trauma part 1: Physical principles and pathophysiology]","volume":"125","author":"Hauer","year":"2022","journal-title":"Unfallchirurg"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1007\/s00113-021-01135-y","article-title":"Explosionstrauma Teil 2: Medizinische Behandlungsprinzipien [Blast injuries part 2: Principles of medical treatment]","volume":"125","author":"Hauer","year":"2022","journal-title":"Unfallchirurg"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"94S","DOI":"10.1177\/10806032241227460","article-title":"Wilderness Medical Society clinical practice guidelines for the treatment and prevention of drowning: 2024 update","volume":"35","author":"Davis","year":"2024","journal-title":"Wilderness Environ. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1177\/10806032241249126","article-title":"Wilderness Medical Society clinical practice guidelines for medical direction of search and rescue teams","volume":"35","author":"Davis","year":"2024","journal-title":"Wilderness Environ. Med."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Maier, M., Maier, L.P.N., Hackl, S., Eckermann, N.J., Maffulli, N., Barapatre, N., and Schmitz, C. (2026). At times, hunters should beware. Trauma from wild boar encounters during hunting: A nationwide survey in Germany with a systematic literature review. Brit. Med. Bull., submitted.","DOI":"10.20944\/preprints202601.1661.v2"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1177\/10806032251347933","article-title":"Traumatic knee arthrotomy induced by wild boar tusk in a 15-year-old male: A case report","volume":"37","author":"Ammann","year":"2026","journal-title":"Wilderness Environ. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"145","DOI":"10.4103\/jets.jets_47_25","article-title":"Open digital fractures by boar bite","volume":"18","author":"Okamoto","year":"2025","journal-title":"J. Emerg. Trauma Shock"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e26386","DOI":"10.1016\/j.heliyon.2024.e26386","article-title":"Correlates and impacts of human-mammal conflict in the central part of Chitwan Annapurna Landscape, Nepal","volume":"10","author":"Adhikari","year":"2024","journal-title":"Heliyon"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"102459","DOI":"10.1016\/j.legalmed.2024.102459","article-title":"Boar hunt or Manhunt? fatality during a wild boar hunting expedition. Need for a multidisciplinary forensic approach","volume":"69","author":"Iacoponi","year":"2024","journal-title":"Leg. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1177\/10806032241226617","article-title":"Common peroneal nerve injury caused by a wild boar attack","volume":"35","author":"Acet","year":"2024","journal-title":"Wilderness Environ. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"496","DOI":"10.13004\/kjnt.2023.19.e59","article-title":"Penetrating head injury resulting from wild boar attack in republic of korea: A case report","volume":"19","author":"Na","year":"2023","journal-title":"Korean J. Neurotrauma"},{"key":"ref_23","first-page":"455","article-title":"Foreign body in chest wall with traumatic pneumothorax caused by fang of wild boar","volume":"76","author":"Shimizu","year":"2023","journal-title":"Kyobu Geka"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"27","DOI":"10.4038\/amj.v17i3.7802","article-title":"The wild boar Sus scrofa cristatus attacks in Sri Lanka: A case series and review of literature","volume":"17","author":"Thalgaspitya","year":"2023","journal-title":"Anuradhapura Med. J."},{"key":"ref_25","first-page":"166","article-title":"A rare cause of foot drop: Wild boar bites","volume":"76","author":"Zaimoglu","year":"2023","journal-title":"J. Ank. Univ. Fac. Med."},{"key":"ref_26","first-page":"254","article-title":"An evaluation of traumatic deaths associated with animal attacks: A 10-year autopsy study","volume":"28","author":"Ketenci","year":"2022","journal-title":"Ulus. Travma Acil Cerrahi Derg."},{"key":"ref_27","first-page":"1494","article-title":"Fatal land hunting-related injuries in the Eastern Black Sea region-Turkey","volume":"28","author":"Ketenci","year":"2022","journal-title":"Ulus. Travma Acil Cerrahi Derg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"191","DOI":"10.5958\/0974-0848.2021.00048.8","article-title":"Exsanguinated to death: A case of death due to wild boar attack","volume":"43","author":"Kiran","year":"2021","journal-title":"J. Indian Acad. Forensic Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"190","DOI":"10.4103\/JETS.JETS_131_20","article-title":"Mechanisms and patterns of animal-related injuries in patients admitted to a major trauma center in central India","volume":"14","author":"Quraishi","year":"2021","journal-title":"J. Emerg. Trauma Shock"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/j.cjtee.2021.09.004","article-title":"Pattern of injuries due to wild animal attack among patients presenting to the emergency department: A retrospective observational study","volume":"24","author":"Singh","year":"2021","journal-title":"Chin. J. Traumatol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Ruda, A., Kolejka, J., and Silwal, A.T. (2020). Spatial concentrations of wildlife attacks on humans in chitwan national park, nepal. Animals, 10.","DOI":"10.3390\/ani10010153"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1007\/s00194-018-0267-1","article-title":"Der vermeidbare (?) Jagdunfall\u2014T\u00f6dliche Oberschenkelverletzung durch ein Wildschwein","volume":"28","author":"Dokter","year":"2018","journal-title":"Rechtsmedizin"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1016\/j.wem.2018.05.003","article-title":"A case of near-fatal drowning caused by an attack from a wild boar","volume":"29","author":"Nagasawa","year":"2018","journal-title":"Wilderness Environ. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1016\/j.wem.2018.02.007","article-title":"Penetrating anorectal injury caused by a wild boar attack: A case report","volume":"29","author":"Okano","year":"2018","journal-title":"Wilderness Environ. Med."},{"key":"ref_35","first-page":"e-201801001","article-title":"The nature of attacks by wild boar (Sus scrofa) and wild boar\/domestic pig hybrids (\u201cJavaporcos\u201d) and the conduct of anti-rabies care in Brazil","volume":"1","author":"Vargas","year":"2018","journal-title":"InterAm. J. Med. Health"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"285","DOI":"10.4103\/JDRNTRUHS.JDRNTRUHS_86_17","article-title":"Unusual cause of chest trauma: Case report of wild boar attack","volume":"7","author":"Singaravelu","year":"2018","journal-title":"J. Dr. NTR Univ. Health Sci."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/j.wem.2017.06.004","article-title":"Bite wounds caused by a wild boar: A case report","volume":"28","author":"Nagasawa","year":"2017","journal-title":"Wilderness Environ. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1017\/S0030605315001489","article-title":"When, where and whom: Assessing wildlife attacks on people in Chitwan National Park, Nepal","volume":"51","author":"Silwal","year":"2017","journal-title":"Oryx"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1177\/0025817217707166","article-title":"Human fatalities caused by animal attacks: A six-year autopsy study","volume":"85","author":"Tumram","year":"2017","journal-title":"Med. Leg. J."},{"key":"ref_40","first-page":"PD03","article-title":"A case of recto-vesico-cutaneous fistula following perineal injury by wild boar","volume":"10","author":"Bhingare","year":"2016","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"100","DOI":"10.5958\/0974-0848.2015.00025.1","article-title":"Fatal penetrating lacerated wound by tusk of indian wild boar","volume":"37","author":"Akhade","year":"2015","journal-title":"J. Indian Acad. Forensic Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1177\/0025817214528431","article-title":"Fatal tusk injuries from a wild boar attack","volume":"83","author":"Tumram","year":"2015","journal-title":"Med. Leg. J."},{"key":"ref_43","first-page":"1211","article-title":"The wild boar attack--a case report of a wild boar inflicted injury and treatment","volume":"38","author":"Sprem","year":"2014","journal-title":"Coll. Antropol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.wem.2013.03.018","article-title":"Patterns of game animal attacks on hunters in Croatia over a 13-year period","volume":"24","author":"Sprem","year":"2013","journal-title":"Wilderness Environ. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1007\/s12663-010-0123-7","article-title":"Wild boar inflicted human injury","volume":"10","author":"Attarde","year":"2011","journal-title":"J. Maxillofac. Oral Surg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1016\/j.wem.2011.06.005","article-title":"Management of a wild boar wound: A case report","volume":"22","author":"Kose","year":"2011","journal-title":"Wilderness Environ. Med."},{"key":"ref_47","first-page":"2","article-title":"Death\u2014Who Caused It? Wild Boar or Doctor\u2014Case Report","volume":"11","author":"Rajendra","year":"2011","journal-title":"Anil Aggrawal\u2019s Internet J. Forensic Med. Toxicol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1580\/08-WEME-LE-192.1","article-title":"Fatal craniocerebral injury from wild boar attack","volume":"19","author":"Shetty","year":"2008","journal-title":"Wilderness Environ. Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1580\/06-WEME-CR-033R1.1","article-title":"Wild boar attacks","volume":"18","author":"Gunduz","year":"2007","journal-title":"Wilderness Environ. Med."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.jcfm.2005.08.007","article-title":"Death by attack from a wild boar","volume":"13","author":"Manipady","year":"2006","journal-title":"J. Clin. Forensic Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1016\/S0140-6736(05)64756-3","article-title":"Actinobacillus suis infection after a pig bite","volume":"348","author":"Escande","year":"1996","journal-title":"Lancet"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1580\/0953-9859-3.3.288","article-title":"Septic arthritis of the knee induced by Pasteurella multocida and Bacteroides fragilis following an attack by a wild boar","volume":"3","author":"Gubler","year":"1992","journal-title":"J. Wilderness Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1016\/S0363-5023(10)80030-9","article-title":"Swine bites of the hand","volume":"16","year":"1991","journal-title":"J. Hand Surg. Am."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1128\/jcm.28.5.1079-1081.1990","article-title":"Recovery of an unusual Flavobacterium group IIb-like isolate from a hand infection following pig bite","volume":"28","author":"Goldstein","year":"1990","journal-title":"J. Clin. Microbiol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1017\/S0950268800029514","article-title":"Pig bite injuries and infection: Report of seven human cases","volume":"101","author":"Barnham","year":"1988","journal-title":"Epidemiol. Infect."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"649","DOI":"10.5694\/j.1326-5377.1988.tb120813.x","article-title":"Injuries caused by pigs in Papua New Guinea","volume":"149","author":"Barss","year":"1988","journal-title":"Med. J. Aust."},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"ATLS Subcommittee, American College of Surgeons\u2019 Committee on Trauma, and International ATLS Working Group (2013). Advanced trauma life support (ATLS\u00ae): The ninth edition. J. Trauma Acute Care Surg., 74, 1363\u20131366.","DOI":"10.1097\/01586154-201305000-00026"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1186\/s13054-023-04327-7","article-title":"The European guideline on management of major bleeding and coagulopathy following trauma: Sixth edition","volume":"27","author":"Rossaint","year":"2023","journal-title":"Crit. Care"},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Bezati, S., Ventoulis, I., Verras, C., Boultadakis, A., Bistola, V., Sbyrakis, N., Fraidakis, O., Papadamou, G., Fyntanidou, B., and Parissis, J. (2025). Major bleeding in the emergency department: A practical guide for optimal management. J. Clin. Med., 14.","DOI":"10.3390\/jcm14030784"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1017\/cem.2019.381","article-title":"Diagnostic accuracy of eFAST in the trauma patient: A systematic review and meta-analysis","volume":"21","author":"Netherton","year":"2019","journal-title":"Can. J. Emerg. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7381\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T08:56:39Z","timestamp":1790153799000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7381"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,23]]},"references-count":60,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["jcm15197381"],"URL":"https:\/\/doi.org\/10.3390\/jcm15197381","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,23]]}}}