All-terrain vehicles (ATVs) have become increasing popular in many countries around the world, both for occupational use, as well as recreational use. With an increase in popularity, and the supply of heavier and more powerful machines on the market, major traumas and deaths from ATV use are growing concerns for public health and injury prevention professionals. This review of the literature on ATVs will focus on the mechanism and patterns of ATV-related injuries, the challenges of injury prevention, and the effects of legislation and regulations regarding ATV usage. The increasing burden of injuries and the substantial economic cost from ATV-related traumas and deaths calls for intensification of injury prevention efforts. Modification of risk factors, institution of regulations and legislation, and enforcement of those rules are important steps for prevention of ATV-related harm.