OCF is an uncommon injury requiring computed tomographic imaging for diagnosis. Patients sustaining high-energy blunt craniocervical trauma, particularly in the setting of loss of consciousness, impaired consciousness, occipitocervical pain or motion impairment, and lower cranial nerve deficits, should undergo computed tomographic imaging of the craniocervical junction. Untreated patients with OCF often develop lower cranial nerve deficits that usually recover or improve with external immobilization. Identification of Type III OCF should prompt external immobilization. Additional treatment may be dictated by the presence of associated cervical fractures or instability.