The optimal management of type II odontoid fractures continues to generate controversy in the literature. There is ahigh rate of nonunion and malunion reported with displaced type II odontoid fractures treated nonoperatively. Posterior atlantoaxial arthrodesis is the most frequent procedure performed in this country to treat this condition. Loss of cervical mobility necessarily results and may lead to functional disability in young, active patients. Direct anterior screw osteosynthesis of the odontoid was initially described 15 years ago to treat displaced odontoid fractures without arthrodesis. This technique involves an indirect reduction of the fracture followed by interfragmentary compression with screw fixation. The purpose of this article is to review the technical aspects of this procedure. We will also examine the indications, surgical results, and complications associated with anterior screw osteosynthesis. Screw fixation of displaced type 11 odontoid fractures remains a valuable tool in the armamentarium of the spinal surgeon.