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Odontoid fractures are the most common cervical spine fracture in the elderly, and their incidence is increasing. The majority of these fractures are Type II and are associated with significant morbidity in the elderly population, irrespective of treatment options (surgical vs. nonsurgical). There is no clear consensus regarding the long-term morbidity of nonunion, with some authors advocating stable fibrous nonunion as an acceptable endpoint versus bony union. Surgical management is advocated by some due to the significantly greater union rate, and some studies report improved outcomes with surgery. Prospective studies are needed to better delineate optimal treatment.