The authors present details of 22 fractures of the atlas treated at the Orthopaedic Clinic of the University of Athens between 1970 and 1982. After a brief survey of the basis of classification of the four types of fracture, the mechanism of injury, the clinical and radiological presentation and the treatment of these injuries, the authors analyse their own cases and examine their results. Such fractures may go unrecognised because of more obvious associated injuries at other levels in the cervical spine. Neurological signs are uncommon. Treatment has always been orthopaedic and the results are usually excellent.