A 5-year review of skiing injuries in the Aspen/Snowmass area revealed 18 cervical fractures. This represents a yearly average of 3.6 fractures (range: 2 to 5). There were 16 men and 2 women identified, with an average age of 40.8 years (range: 20 to 73). Using estimates of skier days and total injuries, cervical fractures represented approximately 0.1% of all skiing injuries. Six of 18 injuries (33%) were avulsion injuries of the spinous processes and were treated symptomatically with a soft collar. However, five patients had neurologic involvement secondary to fracture displacement, two with lasting quadriparesis. In addition, there was one death attributed to cervical fracture. Forty-four percent of the patients had associated injuries, most commonly facial and head (33%). The three oldest patients (average age: 67 years, range: 57 to 73) had three of the more serious injuries. Two of these patients were the quadriplegics, and a third required halo stabilization of bilateral C2 facet fractures. Typically, those patients who were involved in collisions with immovable objects (trees or fences) had more severe injuries and a greater chance of neurologic involvement.