Despite an abundance of evidence on the morbidity and mortality associated with all-terrain vehicle (ATV) accidents, use of ATVs continues to increase, with corresponding increases in the frequency of associated injury and death. Children and adolescents account for a disproportionately large percentage of injuries. However, the number of accidents involving persons aged >50 years is increasing, as well. Legislative and educational initiatives have been unsuccessful in substantially reducing the number of ATV-related injuries and deaths. Because musculoskeletal injury is commonly associated with ATV accidents, orthopaedic surgeons have the opportunity to play a pivotal role in the prevention and management of ATV-related injury and death.