The upper cervical region consists of the skull base, atlas, and axis bones. Injuries in this region are usually a consequence of high-energy trauma. Conservative treatment modalities such as traction and orthesis may be applied in selected patients, however, surgical intervention is necessary especially if there is instability or neural compression. The main purposes of surgical treatment are to achieve neural decompression, pain control, prevention and correction of segmental collapse and deformity, mechanical restoration and early ambulation. Different surgical techniques including interlaminar clamps, wiring and screw fixation have been defined depending on the fracture types. The type of surgical approach is determined by the fracture type, existence of an anatomical variation, the age and comorbidities of the patient. For instance, alternative screw fixation techniques should be considered if there is a variation of the vertebral artery or the pedicle size is small. Biomechanical studies have shown that unilateral and bilateral fixation are both effective in achieving stability. In this article, we discussed the important aspects of preoperative planning of patients with upper cervical trauma and presented salvage surgical techniques.