A detailed review of 88 consecutive patients placed in skeletal tong traction for cervical fractures by the University of Louisville Neurosurgical Service during a 5-year period from July 1, 1979, through June 30, 1984, was carried out. Of this group, 60% of the patients had a major associated injury consisting of major facial and skull fractures, cerebral contusions or intracerebral blood clots, cardiac or pulmonary contusions, major thoracic injuries including rib fractures and hemo- or pneumothoraces, intra-abdominal injuries, and major extremity fractures. An additional 24% of the patients had minor associated injuries, including facial or scalp lacerations, general body lacerations, or abrasions and cerebral concussions. Only 16% of patients with cervical fractures had no evidence of any other associated injury. Acute cervical spine fractures require prompt assessment and resuscitation by personnel from multiple specialties, usually available only in major trauma centers where experienced personnel capable of handling diverse injuries are always present.