Abstract:Objective To observe the clinical outcome of posteromedial inverted "L" incision for exposing three windows combined with anterolateral approach in the operation of complex tibial plateau fracture. Methods Twenty-one patients with complex tibial plateau fracture treated with posteromedial inverted "L" incision combined with anterior lateral approach from March 2013 to March 2017 were enrolled, and there were 15 male and 6 female, aged from 21 to 65 years old, in whom 13 cases of fracture located on the left and 8 cases on the right.According to Schatzker classification, the fractures were diagnosed as type Ⅳ in 7, type Ⅴ in 10, type Ⅵ in 4.According to Three-Column classification, there were 14 cases of two-column fracture, 7 cases of three-column fracture.The operation time, condition and time of fracture healing, follow-up time in each patient were recorded.On the 3rd day after operation, positive and lateral X-ray of knee, CT plain scan, multiplanar reconstruction and 3D reconstruction of knee were performed.At 3-, 6-, 9-, 12- month, the related examinations were performed for all patients, and the knee joint functions were assessed by Hospitial for Special Surgery（HSS）score and Rasmussen knee function score. Results The mean operation time was (179.4±42.3) min, and all the patients gotbony union.The average healing time was (16.5±5.6) weeks, and mean followed-up was (22.6±5.7) months.At the last follow-up, HSS score was 66-100 (85.3±4.2) , with excellent and good rate of 95.2%; Rasmussen score of reduction and radiology for tibial plateau fractures ranged from 7 to 18 (15.8±1.6) , with an excellent and good rate of 90.5%.After operation, there were 1 case of wound dehiscence and 1 case of wound epidermal necrosis, cured by conservative treatment.Numbness under the calf and internal fixation loosening were respectively found in one patient, but did not affect fracture healing.No other complications (such as breakage of internal fixator and so on) occurred. Conclusion The posteromedial inverted "L" incisionfor exposing three windows combined with anterolateral approach could fully expose the operative area and have accurate reduction of fracture under direct vision, which is conducive to early functional exercise, fewer complications and satisfactory clinical effect.