Forty-one cases of C2 odontoid process fractures, from a group of 273 surgically treated cervical spine trauma patients, were treated by anterior screw fixation during a 6-year period. There were 37 patients with Anderson and D'Alonzo type II. fractures and 4 with type III. The mean age of the patients was 52 years and the fracture was caused by falls in most cases. Medical complications were not observed during surgery, but in 3 patients, implant-related technical problems were recorded. In the 3-month follow-up, 2 patients died because of medical complications not related to the procedure. There were no other complications in the remaining patients. We included 21 patients in a 6-month follow-up. In 19 of them, the fracture healed (90.5%), while in 2 patients osteosynthesis failed, which required further stabilization. In the authors' opinion, direct osteosynthesis should be considered the method of choice in most C2 type II fractures as well as in some of type III fractures.