OBJECTIVE: To examine the risk of disability from unintentional injury in teenagers and young adults. METHODS: Analyses of data from the National Child Development Study, a follow up study of 98% of all children born in England, Scotland, and Wales in one week in March, 1958. In 1981, 12,537 study participants, 76% of the original cohort, were asked about unintentional injuries since age 16 years requiring hospital treatment, and whether these injuries resulted in permanent disability. RESULTS: 62% of men and 26% of women reported at least one accident since age 16 resulting in injury that required hospital treatment. Of these accidents, 3.2% caused permanent disability. The risk of disability increased with accident frequency. Injuries requiring hospital admission carried the highest risk of disability (9.7%). However, 54% of permanent disability reported by men and 74% reported by women resulted from injuries treated as outpatients. Road traffic accidents caused 42% of admissions and 31% of disability. Fractures constituted 21% of all injuries but were responsible for 32% of permanent disabilities. Of the permanent disabilities resulting from work related accidents, 82% involved the hand. Of the permanent disabilities resulting from accidents in the home, 32% involved the hand. CONCLUSIONS: The targeting of prevention strategies towards the major causes of injury mortality may have a smaller impact on population levels of injury related disability. Non-life threatening injuries, in particular injuries to the hand and limb fractures, resulting from accidents in the workplace, the home, and during sports, make a significant contribution to the prevalence of permanent injury related disability in young adults.