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Two cases of type II odontoid fractures were reported to share our experience in surgery treatment of such cases. A 33-year-old woman with comminuted type II odontoid fracture and a 42-year-old man with fracture end hardened type II odontoid fracture received surgical treatment in our hospital. Though imaging examination suggested that these two patients were suitable for anterior screw fixation, we encountered difficulties during the operation. The two patients eventually underwent posterior Cn 1-Cn 2 fusion surgery and recovered well. According to the experience of these two cases, we found that the fracture line angle and the degree of comminution are two important factors affecting surgical decision-making. Although anterior screw fixation is the ideal choice for type II odontoid fractures with anterior superior to posterior inferior fracture line, it may not be the best choice for comminuted or fracture end hardened type II odontoid fractures.n “,”Two cases of type II odontoid fractures were reported to share our experience in surgery treatment of such cases. A 33-year-old woman with comminuted type II odontoid fracture and a 42-year-old man with fracture end hardened type II odontoid fracture received surgical treatment in our hospital. Though imaging examination suggested that these two patients were suitable for anterior screw fixation, we encountered difficulties during the operation. The two patients eventually underwent posterior Cn 1-Cn 2 fusion surgery and recovered well. According to the experience of these two cases, we found that the fracture line angle and the degree of comminution are two important factors affecting surgical decision-making. Although anterior screw fixation is the ideal choice for type II odontoid fractures with anterior superior to posterior inferior fracture line, it may not be the best choice for comminuted or fracture end hardened type II odontoid fractures.n