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Optimal surgical treatment in elderly patients with type II odontoid fracture is still controversial. The purpose of this study is to investigate the surgical outcomes of anterior screw fixation of type II B odontoid fractures in the elderly.Fifteen patients who had type II B odontoid fracture were treated consecutively by anterior odontoid screw fixation between 2001 and 2005. The patient group comprised 11 men and 4 women. In all patients, 3-D CT reconstructions were checked for accurate diagnosis for type II odontoid fracture. The medical records, plain X-rays, and CT scans of all patients were reviewed and fusion rate, union time, incidence of perioperative complications, neurologic outcome, and mortality were studied. Radiologic and clinical follow-up were performed in all patients.All patients were treated with anterior odontoid screw fixation by use of one compression screw. Mean age was 68.9 years (range, 61–78) and mean follow-up was 18.3 months. The overall fusion rate was 77%. If follow-up studies revealed pseudarthrosis, additional dorsal fixation with transarticular C1–C2 screws or C1–C2 posterior screw-rod fixation with bone graft was performed. Mean union time was 17.1 week.The outcome of anterior odontoid screw fixation of type II B odontoid fractures in the elderly is satisfactory. We experienced satisfactory union rates and preserved cervical range of movement without the need of postoperative rigid neck immobilization. The morbidity associated with this procedure was low. We recommend anterior screw fixation as an effective method of treating type II B odontoid fractures in the elderly.