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A case of type II odontoid fracture with irreducible posterior dislocation is presented. Cervical traction was employed but reduction could not be achieved with up to 15 kg of traction. The patient was treated with intraoperative transoral open reduction combined with anterior-posterior fixation. Rigid fixation and bone union were obtained without any complication in the 12-month follow-up. The patient has restricted C-spine rotation but no neck pain with movement. Transoral open reduction may be considered in patients with irreducible posteriorly displaced odontoid fracture.

Transoral reduction of irreducible posteriorly displaced odontoid fracture