Background <p>Sharp force injuries display varying patterns depending on the manner of death (homicide, suicide, accidental). The purpose of this study was to analyse forensic autopsy data to examine the characteristics of sharp force injuries on the extremities, to differentiate between different manners of death and to examine demographic differences.</p> Methods <p>This retrospective cohort study utilized forensic autopsy reports from the Swedish Forensic Medicine Database. Cases were selected based on sharp force trauma as the cause of death. Injuries to the arms and legs were analysed for severity using a modified Abbreviated Injury Scale (AIS) to assess the trauma burden on the extremities and toxicological data was gathered. Statistical analyses were performed to explore differences in injury patterns and toxicological findings across manners of death as well as between sexes.</p> Results <p>The study included 823 cases, categorized as 403 homicides, 365 suicides, 26 accidents, and 29 undetermined deaths. Suicides were more likely to involve lethal extremity injuries, particularly to the forearms and wrists. The injury severity was significantly higher in suicides than homicides when considering only cases with extremity injuries. Toxicology results showed higher intoxication rates in accidental deaths.</p> Conclusions <p>This study highlights the utility of analysing the anatomical distribution and severity of injuries to the extremities in differentiating between homicides and suicides. Additionally, demographic and toxicological factors, such as age and substance use, provide valuable insights into the circumstances surrounding sharp force deaths.</p>