The routine occupational hazards of flying and parachute jumping place U.S. Army aviators at risk for sustaining high-energy traumatic injuries, such as thoracolumbar fractures. A longitudinal, prospective, epidemiologic database was used to determine the incidence, injury history, and aeromedical disposition of U.S. Army aviators who sustained thoracolumbar fractures for calendar years 1987 to 1997. The overall incidence rate of thoracolumbar fracture was 12.8 per 100,000 aviators per year. Thirty aviators with thoracolumbar fractures were identified, and the average age at time of injury was 35.9 years (range, 25-59 years). Mean follow-up after injury was 6.5 years (range, 2-12 years). Helicopter crashes and parachuting accidents accounted for 73% of fractures. Neurologic injury occurred in 10% of aviators. Seventy-seven percent of injured aviators recovered sufficiently to return to aviation service. There was no association between type of treatment and eventual termination from aviation duties (relative risk, 1.1; 95% confidence interval, 0.7-1.6). Occupational hazards of Army aviators place them at risk for sustaining thoracolumbar fractures. These data are relevant to future decisions for research and resource allocation for aviation safety and policy.