A retrospective review of 262 consecutive cervical spine fractures revealed that 41 (16%) were odontoid fractures. Twenty patients were younger than 40 years of age (19 fractures were the result of a motor vehicle accident), whereas 19 fractures occurred in subjects older than 60 (13 were the result of a fall). Fractures were of the Anderson-D'Alonzo Types I (one patient), II (19 patients), and III (21 patients). Significant displacement was present in 31 patients. Anterior and posterior displacement occurred equally, but most of the anterior fractures were seen in patients younger than 40, and the majority of the posterior fractures occurred in those older than 60. Primary fusion was performed in 12 cases. Conservative management was used in 26. Three patients died (one from a spinal cord transection and two from other injuries). In the conservatively treated group, the average time to healing was 12 weeks, but the overall nonunion rate was nine out of 26 (7/13 Type II, 2/13 Type III fractures). The halothoracic jacket was poorly tolerated in patients older than 75 years of age. If daily supervision is not possible, early C1-2 fusion or treatment in an appropriate brace seems superior in the elderly patient.