This study explores the pattern and forms of trauma sustained by inhabitants of three archaeological sites in western Nepal while traversing the steep and uncertain terrains in high-altitude Himalayan environments, potentially in pursuit or defense of scarce resources in this marginal environment. Findings align with previous research that suggests adults have higher risks of accidental and violence-related trauma than subadults, either from engagement in subsistence activities or from conflicts. The low rate of accidental trauma suggests familiarity with the potential hazards of their terrain and in dealing with any subsistence-related injuries. These findings also complement findings from our previous study that showed relatively low levels of non-specific stress among individuals from these sites. That is, local communities were able to navigate the difficulties in this environment through biocultural adaptations, so confrontations for limited resources and similar tensions were relatively rare. Yet, the evidence of an embedded projectile and at least one antemortem cranial fracture from a sharp weapon, along with other perimortem cranial fractures and nasal damage, indicate that violence did occur occasionally. Overall, our findings suggest that accidents and violent confrontations were relatively low risks for those who lived in these high-altitude communities.