Objective To analyze intraoperative mismanagements in anterior single-screw fixation of odontoid fractures.Methods From April 2002 to July 2010, intraoperative mismanagements happened in the treatment of 15 cases of fresh odontoid fracture with anterior single-screw fixation under C-arm fluoroscopy.They were 10 men and 5 women, aged from 22 to 65 years (average, 37 years).All the fractures were Anderson-D' Alonzo type Ⅱ.The mismanagements were characterized to find out their reasons.Results The mean follow-up time was 13.4 months (range, 6 to 47 months).All the fractures healed in an average of 14.5 week (range, 12 to 34 weeks) after operation, no severe complications were found.The intraoperative mismanagements could be elassified into 3 kinds.In the first kind, the guide pin was driven through the odontoid bone into the cranial cavity in 3 cases, resulting in one death due to serious injury to the medullary bulb.In the second kind, malreduction happened in 5 cases due to intraoperative displacement of the fracture.In the third kind, poor position and fixation of the screw happened in 7 cases because of enlargement of the screw canal after repeated correction of the guide pin direction.Conclusions The intraoperative mismanagements in anterior single-screw fixation of odontoid fractures were mostly caused by careless surgeons who made their operative assessments and plans before they read the X radiographs of their patients carefully or before they had been familiar with the operative instruments.Secondly, some mismanagements were caused by intraoperative accidents, most of which, however, could have been avoided by careful preoperative preparation and meticulous operative maneuvers. Key words: Fascia dentate; Fractures; Fracture fixation, internal; Therapeutic errors