Background: In modern times, increase in number of road traffic accidents has become an epidemiological concern. Accidents involving two wheelers are also becoming common. Materials and methods: All two-wheeler accidents involving riders and pillion riders were taken up for the study period of one year from 1st September 2004 to 31st August 2005. A pretested proforma was used to determine the nature of the incident and type of vehicle involved. All 76 cases were autopsied and findings recorded and analyzed. Results: Incidence of fatal two wheeler accidents was 16.59%. Most fatal riders were between 21- 30 years (35.52%) while pillion riders were between 31- 40 years. M:F ratio was 4. 43:1. Maximum cases (31.59%) were seen in spring season. Most accidents occurred between 6PM - 12 Mid Night. Accidents in the urban areas accounted for 42(55.26%) cases. Skull fracture was present in 22(64%) pillion riders and in only 16(38%) riders. Rib fractures were seen in 33.3% of riders and 17.64% of pillion riders. Laceration to the brain was seen in 16(38%) riders and 18(52.94%) pillion riders. Laceration to the liver and spleen constituted 19% each in riders while it was 14.7% and 17.6% respectively in pillion riders. Laceration of the heart was seen in 3 riders (7.14%) and 2 pillion riders (4.76%). Conclusion: The study highlights the importance of enforcing speed limits on roads, enforcing laws requiring riders and pillion riders of two wheelers to wear helmets, upgrade road infrastructure and lastly to strengthen the health facilities for the victims. © 2011 Elsevier B.V., All rights reserved.