Background: Motor vehicle crashes are a major cause of fatality all over the world. By 2020 motor vehicle injury is projected to become the third leading contributor to the global burden of disease in the world. Motor cyclists are about 25 times more likely than car occupants to die in Road Traffic Accidents. The present study is aimed to analyse the injury pattern in driver and pillion rider victims of two wheeler accidents. Method: In this study 135 (127 males and 8 females) cases of victims of fatal two wheeler accidents in the age group of 11 to 74 years were studied. The details of the accident were collected from police inquest, statements from investigating officers, statements from relative/witnesses. In hospitalised cases details including laboratory investigation reports are collected from case sheet. General examination findings and injuries are documented and also photographed. Results It was observed that majority of the victims were between 20 and 50 years. Skilled labourers constituted 18.5%. Next were students. only 38.1% were using helmet at the time of accident. In 27.4% of cases definite history regarding helmet use was not available. Probably the relatives may not disclose the non usage of helmet for obvious reasons. It was observed that Majority of the vehicle involved was motorcycle. Majority of accidents were front on collisions. Type of other vehicles involved in accidents was heavy vehicles. Among 135 cases alcohol odour was present for stomach contents in11 victims, 8.3% of drivers and 7.5% of pillion riders. Maxilla was fractured in 11.9% in drivers and 17.64% in pillion riders. Mandible was fractured in 14.28% and 13.72%. Incidence of vertebral fracture was similar in both groups. (14.28% and 14.72%). In drivers and pillion riders head injury was the leading cause of death (70.23% and 66.66%). It includes all cases where head injury was the only cause or occurred in combination with other injuries. Head injury alone was the cause of death in 47% of drivers and 52.9% of pillion riders. Chest injury was the next frequent cause of death. (32.14% and 39.21%). Abdominal injury in 26.19% and 15.68% each. Vertebral column injury in 3.57% of drivers and 7.84% of pillion riders. Conclusion: We conclude that in majority of cases the two wheeler involved was motor cycle and the other vehicle involved were heavy vehicles. The commonest modes of accidents were front on collisions, followed by skid and fall. Only 38.1% of drivers were wearing helmet at the time of accident. Incidence of scalp contusion in pillion riders were more, may be due to helmet use in38.1% of the drivers. Scalp lacerations were more in drivers. Pillion riders showed more fissure fractures in skull vault. Base of skull fractures showed similar incidence in both groups.SDH and brain stem injuries were slightly more in pillion riders. Intra cerebral haemorrhage was seen in pillion riders only.