The unique anatomy of the upper cervical spine and the typical mechanisms of injury yield a predictable variety of injury patterns. Traumatic ligamentous injuries of the atlanto-occipital joint and transverse atlantal ligament are relatively uncommon, have a poor prognosis for healing, and often respond best to surgical stabilization. Bony injuries, including occipital condyle fractures, atlas fractures, most odontoid fractures, and traumatic spondylolisthesis of the axis, generally respond well to nonsurgical management. Controversy in management remains, however, especially with type II odontoid fractures.