20% of all spine injuries are cervical spine injuries. Surgical treatment of these injuries must take into account the great mobility of this part of the spinal column. Therefore, biomechanical aspects must be considered, especially in the upper cervical spine, C1 and C2 (1). In this paper, a case of a fresh type II fracture, according to Anderson & D'Alonzo classification, of the odontoid process treated firstly with posterior approach and secondly with direct screw fixation is reported. A 52-year-old man complained of severe neck pain and limitations of neck motions following a hit on his forehead incurred in a falling accident in moving vehicle. Neurological examination was normal. Cervical spine x-ray films and axial and tree D-CT and MR scans revealed a fracture at the base of the dens. Five days after the injury, the patient operated with posterior approach, wiring of atlanto-axial bone and grafting with autologue iliac wing bone was performed. 5 month after operative procedures, no fusion was seen and with a second operation, this odontoid fracture was directly fixed with a K screw by an anterior cervical approach. Immediately after the operation, his neck pain disappeared. He returned to his previous job 1 months after second surgery without any limitation of his neck movement. For proper assembly of this method, the following two points are particularly recommended: a screw insertion perpendicular to the fracture plane and the use of an optimal screw with both the desired total and thread lengths.