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All-terrain vehicles (ATVs) were introduced in the early 1970s. Injury rates in children and adolescents were alarming. The Consumer Products Safety Commission 2002 annual report revealed 5239 deaths attributed to ATVs between 1982 and 2002. One third (n = 1706) involved children younger than 16 years. The Consumer Products Safety Commission entered into a 10-year decree with ATV manufacturers in 1988 in an attempt to decrease ATV injuries and deaths. The purpose of this study was to assess the experience at the Oklahoma University Medical Center Level 1 Trauma Center by review of the trauma registry for patients younger than 16 years injured in ATV accidents.A retrospective review of the trauma registry was performed in children younger than 16 years who presented as a result of injury attributed to 3- or 4-wheel ATVs since 2001.A total of 73 patients fit the search description. The average age was 9.9 years. The average Injury Severity Score was 10.3 (Level 1 trauma, 20.0; Level 2 trauma, 8.3). All 4 deaths were attributed to head injury (average age, 12.5 years.). The most common injuries were extremity fractures (36 fractures), head injury (33 injuries), and facial trauma (20 injuries). Of the fractures, 8 were open (6 upper extremities all around the elbow and 2 lower extremity tibia fractures). Extremity fractures occurred in nearly half of our patients with a slightly higher number of upper extremity injuries. The rate and severity of fractures about the elbow is especially alarming.All-terrain vehicle injuries involving children continue to be a concern. Despite the 1988 decree, ATV injuries continue to be a significant source of morbidity and mortality among children. Orthopaedic injuries of the extremities are common in these patients. In this series, the only cause of death was head injury.Orthopaedic injuries are the norm in children and adolescents injured in ATV accidents. Although some legislation is in place, the level of compliance is unclear. Legislation requiring helmet use and age limits failed in Oklahoma this year. Perhaps a comprehensive community education program would be the most effective in decreasing ATV morbidity and mortality in children.