OBJECTIVE: Seven percent of tibial plateau fractures are postero-lateral and require anatomical repositioning for internal fixation. In this paper, we introduce a new surgical approach without the need for fibular head osteotomy and analyze its clinical efficacy. Liu Wei, Department of Orthopedics, Nantong First People’s Hospital METHODS: From October 2010 to February 2012, eight patients with simple postero-lateral tibial plateau fractures were admitted, including five cases of car accident and three cases of fall injury, with an average age of 38.6 years (26~55 years). All patients underwent 3D CT and MRI preoperatively to understand the fracture and exclude ligamentous injury. ota typing, 3 cases of 41B1 type, 2 cases of 41B2 type, and 3 cases of 41B3 type. The fracture surface was exposed by a straight posterior-lateral knee incision, 10-350 px long, with the common peroneal nerve exposed and protected, the knee flexed, the lateral head of the gastrocnemius muscle distracted outward or inward, the medial infrapopliteal vessels protected, the joint capsule and meniscus incised and pre-sutured, the fracture surface exposed, and the N muscle bluntly separated and freed downward, never cutting the N muscle to prevent lateral rotation instability of the knee. The fracture is repositioned under direct visualization, the articular surface is viewed, and a “T” or “L” type locking plate is fixed. After surgery, the posterior horn of the lateral meniscus and posterior joint capsule were sutured, and the brace was fixed for one month, and functional exercise was removed after one month. RESULTS: The operative time ranged from 70 minutes to 110 minutes (mean 82 minutes), with no vascular or neurological injury. Postoperative X-rays and CT showed anatomic reduction in 6 cases and joint surface collapse of about 2-3 mm in 2 cases. all patients were followed up for 4-16 months, with a mean of 9.6 months, and knee function was stable after 6 months. by the last follow-up, all patients had healed fractures, no inversion or valgus deformity of the knee, and no patient had limitation of extension, and the 2 patients without anatomic reduction had limitation of flexion of 5-10°. At the longest follow-up of 16 months, there were no early signs of osteoarthritis on imaging, no persistent knee pain, and all patients were able to walk normally and were satisfied with joint function. Conclusion: The posterior lateral tibial plateau fracture requires anatomic internal fixation, and the early posterior “S”-shaped large incision is highly traumatic, easy to accidentally injure the N vessels and tibial nerve and common peroneal nerve, and requires fibular osteotomy, which is limited in clinical application. In contrast, a straight posterolateral incision can better reveal the fracture, and only the joint capsule needs to be cut, which will not damage the vascular nerve or the ligament structure that maintains the stability of the posterolateral side, and can obtain better clinical results. Keywords: postero-lateral; postero-lateral angle; tibial plateau; fracture