Although odontoid fractures were first classified more than 25 years ago, 5 the management of these fractures remains controversial. Whereas the nonoperative management with external immobilization devices often leads to successful healing, certain fracture features and patient characteristics have been associated with an increased risk of bone nonunion. 6,17 Recent technological advances in cervical spine instrumentation techniques have provided additional options for the management of these common fractures. 1,12,13,24,27,28 However, an absence of rigorous studies in which the investigators compare management methods may contribute to the varying methods used by spine surgeons when approaching similar injuries. In this issue of Neurosurgical Focus, various aspects of the management of odontoid fractures are examined. In an evidence-based analysis of methods for treating odontoid fractures the authors examine the best available published data to determine the level of scientific data supporting the use of various treatment options. 3 In epidemiological studies the investigators examine factors contributing to the unusual incidence of spinal cord injury with odontoid fractures as well as the unique considerations that may be attendant on the management of posteriorly displaced fractures. In two other studies the authors discuss the application of specific surgical techniques in treating odontoid fractures, whereas in an additional two reports the authors evaluate the difficulties in managing elderly patients with these injuries. Finally, the use of newer osteoinductive agents is examined as a potential adjunct in the surgical management of bony defects in the dens.