CASE: A 31-year-old man sustained a C1 lateral mass fracture. He underwent C1-ring osteosynthesis, a motion preserving technique that obviates the need for spinal fusion. At 1-year follow-up, the patient had full neck range of motion, had returned to work, and was happy with the outcome of the surgery. CONCLUSION: We describe a step-by-step approach to C1 fracture fixation and illustrate the utility of C1-ring osteosynthesis for the treatment of unstable C1 injuries.