Objective To compare the clinical efficacy of anteromedial combined anterolateral approach and posteromedial combined anterolateral approach in the treatment of hyperextension tibial plateau fracture.Methods Data of 72 patients with hyperextension tibial plateau fracture treated with anteromedial or posteromedial combined anterolateral approach in the Department of Orthopedics of Luliang People’s Hospital from April 2018 to April 2022 were retrospectively analyzed，and they were divided into group A and group B according to treatment methods.Patients of Group A underwent anteromedial combined anterolateral approach surgeries.Group A had 35 patients，including 25 males and 10 females.The patients aged 20~73 years，with an average age of (46.31±14.56) years.Patients of Group B underwent posteromedial combined anterolateral approach surgeries.Group B had 37 patients，including 26 males and 11 females.The patients aged 23~73 years，with an average age of (45.30±14.51) years.Operation time，intraoperative blood loss，weightbearing activity time，visual analogue scale (visualanaloguescale，VAS) and postoperative complication rates were compared to assess the clinical efficacy of two groups.American hospital for special surgery (hospitalforspecialsurgery，HSS) Knee joint scoring criteria were used to assess knee joint function.The changes of posterior inclination and varus Angle of tibial plateau were evaluated by X-ray.Results All 72 patients were followed up for 12~28 months，with an average of (17.93±4.13) months.All fractures healed clinically and the function of knee joint returned to normal.There was no statistically significant difference in knee HSS score between the two groups at 6 months after surgery (P＞0.05)，but the knee HSS score of group A was lower than that of group B at 12 months after surgery，the difference was statistically significant (P＜0.05)，and the excellent and good knee function rate of group A was significantly lower than that of group B，the difference was statistically significant (P＜0.05).The operative time，intraoperative blood loss，postoperative 1 d and 3 d VAS scores and posterior inclination of tibial plateau in group A were higher than those in group B.The time of weightbearing activity and the varus Angle on the day after operation in group B were higher than those in group A，and the difference was statistically significant (P＜0.05). Conclusion The short-term follow-up treatment of hyperextension tibial plateau fracture using the posteromedial combined anterolateral approach is more effective.Due to the small number of cases and lack of long-term follow-up results，further observation and study are needed.