C1 fractures are complex injuries occurring at the top segment of the upper cervical spine and represent an important intervention area for spine surgeons. These fractures typically result from high-energy traumas and carry a significant risk of serious neurological damage. Accurate diagnosis and management are vital for preserving and improving the patient`s neurological function. The management of C1 fractures requires a detailed assessment and an individualized approach. Radiological imaging plays a critical role in the accurate diagnosis of fractures, while CT and MRI are used to classify the fractures, aiding in treatment planning. Treatment includes conservative methods and surgical interventions, where the most appropriate method is selected based on the patient`s condition and the type of fracture. Surgical methods include atlas osteosynthesis, posterior C1-C2 fusion, transarticular screw fixation, C1 lateral mass and C2 pars screw fixation, and occipitocervical fusion. These treatments aim to ensure spinal stability, protect, and improve neurological function. Each fracture and ligament injury requires specific treatment protocols, thus accurate classification and management are fundamental steps in optimizing patient outcomes.