The purpose of this study is to compare the safety and effectiveness of surgical versus conservative management of type II odontoid fractures among patients > 64 years of age. Of secondary interest is to determine if there are differences in outcomes between anterior screw fixation and posterior fusion of these fractures.

Hypotheses are as follows:

• Patients receiving surgical management will exhibit better disease specific health and general health related quality of life measures compared to those managed conservatively.
• The rate of radiographic bony fusion will be greater among elderly patients receiving surgical fixation compared to patients receiving conservative management.
• The rate of non union will be greater in the conservative group compared to the surgical group.
• The complication rate will be higher in the surgical group due to the nature of the intervention though the rate of severe and serious complications will be low.

Inclusion Criteria:

• All new type II odontoid fractures including those in which the fracture line crosses into the body of C2
• Age > 64
• Stable and unstable fractures
• < 3 months post-injury
• No previous treatment for an odontoid fracture

Exclusion Criteria:

• Pathological fractures unrelated to osteoporosis
• Severe dementia or severe mental health problems
• Participation in other trials or unlikely to attend follow-ups

Subjects receiving care for acute Type II Odontoid Fracture in participating investigational sites