The purpose of this study is to compare the safety and effectiveness of surgical versus conservative management of type II odontoid fractures among patients >/= 65 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.

Inclusion Criteria:

• All new type II odontoid fractures including < those in which the fracture line crosses into the body of C2 < as long as it doesn't enter the superior articular process of C2
• Age 65+
• Stable and unstable fractures
• < 3 months postinjury
• No previous treatment for an odontoid fracture

Exclusion Criteria:

• Pathologic fractures unrelated to osteoporosis
• Severe dementia or other severe mental health problem if there is no consentable surrogate available
• Participating in other trials or unlikely to attend follow-ups