Background: Injuries related to the Hindu festival of Dahihandi where a human pyramid is formed and a pot of money kept at a height is broken, celebrated in the state of Maharashtra, have seen a significant rise in the past few years. The human pyramid formed is multi-layered and carries with it a high risk of injury including mortality. Aims: To evaluate the nature, extent and influencing factors of injuries related to Dahihandi festival. Settings and Design: We present a retrospective analysis of patients who presented in a tertiary care center with injuries during the Dahihandi festival in the year 2010. Materials and Methods: 124 patients′ records were evaluated for timing of injury, height of the Dahihandi pyramid, position of the patient in the multi-layered pyramid, mode of pyramid collapse and mechanism of an injury. A binary regression logistic analysis for risk factors was done at 5% significance level. Statistical Analysis: Univariate and multi-variate binary logistic regression of the risk factors for occurrence of a major or minor injury was done using Minitab™ version 16.0 at 5% significance. Results: Out of 139 patients presented to the center, 15 were not involved directly in the formation of pyramid, rest 124 were included in the analysis. A majority of the patients were above 15 years of age [110 (83.6%)]. 46 (37.1%) patients suffered major injuries. There were 39 fractures, 3 cases of chest wall trauma with 10 cases of head injuries and 1 death. More than half of the patients [78 (56.1%)] were injured after 1800 hours. 73 (58.9%) injured participants were part of the pyramid constructed to reach the Dahihandi placed at 30 feet or more above the ground. 72 (51.8%) participants were part of the middle layers of the pyramid. Fall of a participant from upstream layers on the body was the main mechanism of injury, and majority [101 (81.5%)] of the patients suffered injury during descent phase of the pyramid. Conclusions: There is a considerable risk of serious, life-threatening injuries inherent to human pyramid formation and descent in the Dahihandi festival. Safety guidelines are urgently needed to minimize risk and prevent loss of human life.