Purpose of the Study. At our Department, we prefer surgical treatment of all patients with Type II and III fractures of the dens, regardless of the age, with the exception of non-displaced fractures or perfectly reduced fractures in young patients. Material and Methods. We treated surgically 28 patients 65 years old and older with dens fractures. The group consisted of 13 men and 15 women with a mean age of 77.4 years (range, 65–90 years). According to the type of treatment, anterior srew fixation or posterior C1–C2 fixation, the whole cohort was divided into 2 groups that were subdivided into two age groups of patients 65–74 years old and 75 years old and older. The age group of patients 65–74 years old included 8 patients with a mean age of 68.5 years and the mean age of the age group of patients 75 and more years old was 81 years. The injury was caused in 22 cases by a fall, in 5 by a car accident. Only in 1 case the injury was caused differently. Neurological deficits were found in three patients, all of them Frankel D type. All patients with injury to the dens underwent radiograph examination in the lateral and transoral projections and CT scan including the sagittal and frontal reconstructions of the atlantoaxial complex and in most cases also MRI examination to eliminate injury to the transverse ligament of the atlas. Based on these examinations, the type of injury was determined and method of treatment indicated. Final retrospective evaluation of the patients was carried out at the interval of 12 to 78 months after the primary surgery (mean 31.3 months) taking into account aetiology of the injury, type of injury, neurological finding, method of treatment, union of the dens fracture line or, where appropriate, C1–C2 fusion, stability of the spine and the final outcome. Statistical analysis was based on X2-test. Results. Comparison of the two age groups showed a statistically significant difference in the mortality (p<0.05), with 0% in the younger group and 40% in the older group. In total, mortality within 6 weeks after the injury accounted for 28.6%. Comparison of surgical techniques revealed 21.4% mortality after