Odontoid fractures are a common traumatic upper cervical spine injury. Treatment of Type III odontoid fractures includes skeletal traction for realignment and halo vest immobilization. The authors report an unusual case of severe atlantoaxial ligamentous disruption accompanying a traumatic Type III odontoid fracture. Five pounds of skeletal traction was associated with marked neurological deterioration from unanticipated longitudinal instability. Radiographic findings were identified that were suggestive of extensive ligamentous disruption. Recommendations for individualized patient management are given in the context of related literature.