Upper cervical spine injuries account for about 24% of acute cervical fractures and dislocations of the cervical spine. This chapter includes discussion on acute, traumatic injuries of the upper cervical spine and excludes pathological fractures/dislocations associated with congenital, inflammatory, infective or neoplastic disease. If the fractures are fresh, transverse, completely reducible and if there is not much of comminution or reverse obliquity, they are treated with anterior odontoid screw fixation with 4 mm cancellous lag screws with good results of over 90% union. The biomechanical and clinical results of one versus two screws have been extensively evaluated and not much of difference was found. However, for old fractures or nonunions, primary osteosynthesis has a much lower rate of success.