Background and purpose <p>Cross-country skiing (CCS) is a popular winter activity in Sweden, but little is known about what type of orthopaedic injuries are sustained following accidents in the general population. The purpose of this study was to describe the fracture distribution in accidents during cross-country skiing.</p> Methods <p>In this registry-based observational study, all patients who sustained one or more fractures in CCS accidents registered in the Swedish Fracture Register (SFR) with injury date between January 1, 2015 and June 30, 2022 were included. Fractures were classified using the AO Foundation/Orthopaedic Trauma Association (AO/OTA) fracture classification system. The fracture distribution was described and age and sex differences examined. The proportion of surgically treated fractures per fractured location was assessed.</p> Results <p>During the study period, 1820 fractures in 1766 patients were registered in the SFR. The median age of patients was 56 years, and 63% of fractures occurred in females. Wrist fractures were most common (22%), followed by hand fractures (19%). Upper extremity fractures accounted for 66% of all fractures. Operative treatment was performed on 560 (31%) fractures, but most fractures were treated non-operatively in both adults (n=1070, 64%) and children (n=113, 79%).</p> Interpretation <p>Fractures following CCS injures are more common in females than in males. Most fractures affect the upper extremity and are treated nonoperatively.</p>