The Duration of External Neck Stabilisation (DENS) Trial

Inclusion Criteria: * Rockwood clinical frailty scale (CFS) of 5 or more, or aged 65 years or over; * A recent odontoid fracture (type I-III) (within 3 weeks) as assessed on CT, irrespective of degree of fracture angulation, displacement or canal narrowing; * History of recent trauma (within 3 weeks) * Determined by spinal consultant (or delegated registrar) as suitable for standard care 12-week treatment with hard collar and for randomisation to treatment without a collar * Recruited within 3 weeks of injury Exclusion Criteria: * New neurological deficit (numbness / weakness) attributable to fracture; * Assessed as unable to tolerate a hard collar e.g., dystonia, fixed deformity; * Additional (non-odontoid) cervical spine fracture not suitable for management without a hard collar; * Underlying condition potentially leading to spinal instability, e.g., ankylosing spondylitis, diffuse idiopathic skeletal hyperostosis (DISH); * Fracture suspected to be older than three weeks at the time of assessment; * Consultant spinal surgeon determines fracture requires surgical treatment or is otherwise unsuitable for non-surgical treatment with or without a hard collar; * If not expected to survive to hospital discharge based on concomitant injuries or illnesses.