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As there is still some bias in the treatment algorithms, the working group recommends establishment of a prospective study to result in more objective statements. In the aged population (>80 years), operative therapy is critical as postoperative morbidity complication and mortality rates rise significantly. In these cases, posterior instrumentation or fusion of C1 and C2 is favorable. The technique is demanding and leads to elevated complication and failure rates if modifiers are apparent. Unstable and/or dislocated displaced odontoid fractures are treated by anterior osteosynthesis with 1 or 2 screws. Stable odontoid fractures are treated conservatively non-operatively, but if so regular controls have to be performed. To create an adequate treatment algorithm, dislocation displacement and instability have to be identified. The classification of Anderson and D’Alonzo is still standard. If operation is indicated, many influencing factors have to be considered for appropriate approach and technique. Conservative treatment may also be started within stable nondislocated fractures, but then regular controls have to be performed. However, in the aged population, conservative treatment should be considered as morbidity and mortality rise significantly in the group of >75 years. Operation seems to be standard treatment for odontoid fractures.