Because of its unique anatomy, the upper cervical spine is predisposed to specific fractures and injury patterns. The management of fractures in this region has historically been conservative. Highly effective surgical techniques have been developed recently, often with instrumentation, to help neurosurgeons manage these complex injuries. These techniques are attractive because they are very effective and allow the patient to be removed from a restrictive cervical orthosis early. However, surgical intervention is expensive, subjects the patient to the risks of surgery, and can cause loss or restriction of cervical motion. This article chapter focuses on the common types of upper cervical fractures, the methods of nonsurgical management, and the rationale for these methods.