Dentate fractures are a common cervical spine injury, with a lethality rate of 4% to 11% and accounting for 10% to 20% of all cervical spine fractures. Patients have a clear history of trauma, such as a car accident, fall from a height, or fall on a flat surface. Occipital neck pain is the most common symptom of dentate fractures. Radiating pain in the region of the distribution of the greater occipital nerve, neck stiffness, restricted movement, head and neck instability, and a forced position are also seen. Patients often support their head with their hands. In some patients, upper extremity weakness and lower extremity stiffness are seen, or delayed myelopathy is present. In patients with a high clinical suspicion of dentate fracture, a CT thin-section scan with sagittal and coronal reconstruction of the axial CT should be performed to avoid missing bony injuries in the upper cervical spine. In patients with neurological injury or based on the consideration of whether a dentate fracture is combined with atlantoaxial ligament injury, cervical MRI should be performed to assess the integrity of the transverse atlantoaxial ligament. Dentate fractures are generally classified into three types (Anderson-D’Alonzo typing): Type I is an apical dentate fracture, which is an oblique avulsion fracture of the apical dentate ligament and the attachment of the pterygoid ligament on one side, and is less common. Type II is a fracture involving the neck of the odontoid process, which is the most common and unstable fracture, with forward or backward displacement. Type III is a fracture that extends into the pivotal vertebral body with a large cancellous base below the fracture end, and the fracture line often involves the superior articular surface of the pivot on one or both sides. Type IIA, or partial type III fractures, are comminuted fractures of the dentate base with free bone fragments; this subtype of fracture is referred to as type IIA. The non-union rate of untreated or improperly treated dentate fractures is 42%-72%, and there is also potential atlantoaxial instability, which may lead to acute or chronic injury to the brainstem and spinal cord once displacement occurs, causing severe tetraplegia, respiratory dysfunction, and even death. Therefore, active and appropriate treatment should be taken according to the type, displacement and age of the fracture. Non-surgical treatment For dentate fractures without displacement, Halo frame or cephalothoracic cast is usually used for 8-12 weeks. For displaced dentate fractures, cranial traction should be applied, gradually increasing the traction weight to about 3 kg, with the heaviest not exceeding 5 kg. For patients with anterior dislocation, bi-directional head and neck traction is more likely to reposition them. During the traction process, bedside photos should be taken at any time to understand the reset situation, so as to avoid excessive traction and danger. When the X-ray shows that the fracture is well repositioned, Halo frame or cephalothoracic cast should be fixed for 8-12 weeks under traction. Surgical treatment 1. Anterior dentate screw fixation Indications: Dentate fracture type II and type IIA, especially for type II fracture with the following conditions: fracture separation displaced backward, or displacement >4mm, angle >30°, age >40 years, multiple injuries, and bone not healing even after conservative treatment. Surgical objectives: restoration of anatomical sequence, direct compression and fixation of the fracture; preservation of atlantoaxial joint motion; early functional exercise. 2.Posterior atlantoaxial pedicle screw fixation and fusion Indications: Atlantoaxial fracture combined with atlantoaxial dislocation. Surgical objective: to stabilize and fuse the atlantoaxial joint in anatomic position.