BACKGROUND: Traumatic fractures of the second cervical vertebra are common, representing nearly 20% of all acute cervical spinal fracture-dislocation injuries. They are divided into 3 distinct injury patterns: odontoid fractures, hangman's fracture injuries, and fractures of the axis body, involving all other fracture injuries to the C2 vertebra. OBJECTIVE: An evidence-based overview of the medical and surgical treatment strategies for each axis fracture injury sub-type. RESULTS: Current medical and surgical management of traumatic fractures of the axis. Copyright © 2010 by the Congress of Neurological Surgeons.