OCF is an uncommon injury and requiresCTimaging to establish the diagnosis. Patients sustaining high-energy blunt craniocervical trauma, particularly in the setting of loss of consciousness, impaired consciousness, occipitocervical pain ormotion impairment, and lower cranial nerve deficits, should undergo CT imaging of the craniocervical junction. Untreated patients withOCFcan develop lower cranial nerve deficits that usually recover or improve with external immobilization. Nonsurgical treatment with external cervical immobilization is sufficient in nearly all types of OCF. Bilateral OCF injuries should prompt consideration for more rigid external immobilization in a halo vest device. Surgical treatment (cranio-cervical internal fixation and fusion) may be indicated in patients with OCF who have overt instability, neural compression from displaced fracture fragments, or who have associated occipital-atlantal or atlanto-axial injuries. © 2013 by the Congress of Neurological Surgeons.