STUDY DESIGN. A retrospective cohort study. OBJECTIVE. To evaluate the outcomes of patients with occipital condyle fractures (OCFs) treated nonoperatively and establish factors associated with neck disability. SUMMARY OF BACKGROUND DATA. The majority of OCFs are treated nonoperatively; however, few studies have reported long-term functional outcomes of these patients. METHODS. From 1999 to 2007, 103 patients with OCFs were identified. Of this cohort, 28 patients with 32 fractures met the inclusion criteria. Fracture and patient characteristics, including patient age and sex, Anderson and Montesano fracture type, bilaterality, associated head injury, and fracture displacement, were noted. The Neck Disability Index (NDI) was calculated at final follow-up. RESULTS. Anderson and Montesano type III fractures were the most commonly observed (54%), followed by type II (43%). The mean NDI was 14.0, which correlates with mild disability, and the NDI headache question showed the highest mean disability score of all questions. There was no statistically significant association between NDI scores and fracture type, displacement of fracture, sex, bilaterality, or presence of head injury. Age was associated with NDI scores, with age range of 40 to 60 years having a mean NDI score of 24.3. CONCLUSION. Anderson and Montessano types I, II, and III OCFs may be treated nonoperatively in the absence of ligamentous instability and concomitant cervical injuries with the expectation of mild neck disability regardless of the displacement, bilaterality, sex, or presence of head injury. Greater disability may be expected in patients aged between 40 and 60 years than in other ages. © 2012 Lippincott Williams & Wilkins, Inc.