Type 2 odontoid fractures are the most common fracture

Type 2 odontoid fractures are the most common fracture of the cervical spine in patients >65 years usually due to low energy falls at standing height. In patients > 65 years of age, there is a high risk of nonunion since these fractures occur in a vascular watershed area between the carotid and vertebral arteries.

Studies have shown surgical treatment with a posterior C1-2 fusion increases the fusion rate and decreases the mortality as compared to nonoperative treatment with cervical immobilization in a hard or soft collar.

Halo immobilization in this patient group has known complications, including dysphagia, medical comorbidities, and increase mortality, so is typically avoided in elderly patients.