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Abstract Objective To explore the clinical outcomes and complications of surgical treatment of tibial plateau fractures with posterior column involvement.Methods Forty one patients with tibial plateau fractures with posterior column involvement were retrospectively analyzed.There were 22 men and 19 women，with an average age of 42 years.According to the three column classification system，there were 26 three-column fractures，8 lateral and posterior column fractures，1 medial and posterior column fracture，6 posterior column fractures.The fracture reduction and fixation order was posterior column，medial column and lateral column.Firstly，the patient was placed in prone position，the posterior column fracture was reduced and fixed with postmedial approach，then other column fractures were reduced and fixed with patient in supine position.Patients’ knee pain and range of motion were recorded during follow-up，and knee function was evaluated by hospital for special surgery knee score (HSS) at last follow-up.Results All patients were followed up satisfactorily，with an average follow-up of 12.5 months.At 6 months follow-up，all fractures were healed clinically and radiologically，no loose or broken was seen.The pain was reduced and the range of motion was improved at 6 months and last follow-up compare to 3 months follow-up.The good and excellent rate of HSS score was 81% at last follow-up.Superficial infections occurred in 3 patients，foot numbness occurred in 1 patient，and one patient had less than 90° flexion.Conclusion The postmedial approach combine with other approachesiseffectivein the treatment of tibial plateau fractures with posterior column involvement.The complication rate is low.The three-column concept isuseful in guiding surgical treatment of tibial plateau fractures.
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