OBJECTIVE All-terrain vehicle (ATV)-related trauma is increasing nationally. This study highlights the demographics, mechanisms, and associated orthopaedic injuries for ATV-related traumas that presented to our Level I trauma center over an 8-year period and addresses the effects of statewide legislation on injury occurrences. METHODS Retrospective. METHODS Level I trauma center in West Virginia. METHODS Those presenting to a Level I trauma center with ATV-related injuries between January 2000 and June 2007. RESULTS We reviewed data available for demographics, substance abuse, helmet use, length of stay, discharge disposition, injury mechanism and severity, anatomic location of injuries, and orthopaedic injuries. RESULTS In 2000, 72 individuals presented with ATV-related injuries; this number rose significantly each year to 234 individuals in 2006. Of the 1234 patients over 8 years, 79% were male and 95% were white. The average age was 30 years (range, 1-87 years) with 22% of those injured being aged 16 years or younger. Only 27% of the riders were helmeted. There were 647 (52%) patients who sustained orthopaedic injuries (defined as fractures or dislocations). There was no significant decrease in injury occurrence after the implementation of statewide ATV-related legislation in 2004. CONCLUSIONS This trauma center is in a unique position to highlight a national problem. Over half (52%) of the patients had an orthopaedic injury defined as a fracture or dislocation. Before measures can be implemented to effect change, we must first be aware of the exact nature and spectrum of injuries associated with ATV use.