Abstract: This retrospective study sought to collect a representative sample of motorized two-wheeler crashes having fatal outcome with reference to their age, sex, riding position, type of vehicle, nature of accident, pattern of injuries etc. among the helmeted and non-helmeted riders. We examined the pattern of fatal injuries between the helmeted and non-helmeted motorized two-wheeler crash victims in 134 cases subjected to autopsy during five years from 2000 to 2004. Young adults of the age-group 21-25 years constituted the majority of the victims, 48 (36%) and the 16-30 year age group accounted for 98 (73%) motorized two wheeler deaths. The overall male: female ratio was 1.6:1. Motorcyclists were exclusively male. The male: female ratio of scooterists was 1.7:1, however, among the moped crash victims, this ratio was 1:2.2. Scooterists accounted for the majority of crash victims, 70 (52%) and drivers in all the three categories, 88 (66%), outnumbered the pillion riders, 46 (34%). Sixty-two (46%) victims were helmeted, of which males, 49 (79%), were the majority. Of all the three categories of motorized two wheeler users, non-helmeted victims were far more than the helmeted ones in the moped users, the ratio of helmeted: non-helmeted users being 1:2.4; again in this category, the male: female ratio was 1:4.7. Motorized heavy vehicles were responsible for majority of deaths, 53(40%) while slips on roads etc. accounted for 15 (11%) deaths. All the non-helmeted victims sustained scalp injuries, with 70 (97%) of them suffering fractures to the skull, as compared to 18 (29%) of the helmeted ones. However, as regards the injuries to the thorax and abdomen, the helmeted: non-helmeted victim ratio was 4.3:1. Of the victims who died within one hour of the accidents, 36 (75%) were non-helmeted. Helmets prevent and/or reduce the deaths due to head injury, however in majority of cases, there being multiple injuries, other road safety and injury prevention measures need to be devised and implemented. However the implications for safety measures also deserve consideration.