To explore the clinical effects of fibula osteotomy and anterolateral approaches in the treatment of patients with posterolateral tibial plateau fractures, in order to provide the safer surgical method for patients with posterolateral tibial plateau fractures. Methods A total of 104 cases patients with posterolateral tibial plateau fractures who were admitted to the Huishan District Second People's Hospital of Wuxi from March 2019 to March 2020 were selected as the research objects. According to the random number table, they were divided into the control group (52 cases, anterolateral approach of tibial shaft surgery) and the experimental group (52 cases, fibula osteotomy approach surgery), both were followed up regularly for 17 weeks. The surgical indicators, effect of treatment at 10 weeks after the operation, the knee joint function and range of motion before and 10, 17 weeks after the operation, and the occurrence of related complications after the operation of patients in the two groups were compared. Results The operation time and fracture healing time of patients in the experimental group were shorter than those in the control group, and the intraoperative blood loss was less than that of the control group; the total effective rate of treatment in the experimental group (96.15%) was higher than that in the control group (80.77%) after 10 weeks; Compared with preoperatively, the New York Hospital of Special Surgery (HSS) scores and range of motion of knee joint of patients in the two groups gradually increased 10~17 weeks after operation, and the experimental group was higher than that of the control group at 10 and 17 weeks after operation; the total incidence of complications in the experimental group (7.69%) was lower than that in the control group (23.08%) (all P