All-terrain vehicles (ATV) are designed for off-the-road occupational or recreational use. As their popularity has been increasing steadily, information has been accumulating on the morbidity and mortality associated with their use. The attributes of the ATV that make it attractive for recreation and sport are the reasons for much of its danger. Thus, horsepower, speed and ability to travel on rough and uncertain terrain are causal factors for accidents. The poor judgment and risk-taking of many of the young and immature drivers contribute to the great danger. 61 admissions due to ATV accidents from October 1992 to April 1995 are reviewed. The data suggest that ATV riders are at high risk for serious skeletal injuries and death. ATVs clearly present health hazards for riders of all ages, unless they are driven with great care. Guidelines for reducing the number and severity of injuries, such as age limits, safety programs and protective equipment are suggested.