Abstract: Objective To observe the effect of posteromedial approach and posterolateral approach for posterolateral tibial plateau fractures guided by four-column classification system. Methods From January, 2014 to June, 2016, 14 cases of tibial plateau fracture merge with articular surface collapse were included in the group. There were 11 males and 3 females. The average age was (42.3±8.1) years. The patient had ligamentous injuries, but no meniscus injury. The types of Schatzker fracture were as the follows:8 cases of type Ⅴ, and 6 cases of type Ⅵ. The patients were treated with internal fixation and internal fixation through both posterior and posterior lateral approach. To evaluate the clinical effect of the operation, the fracture healing, HSS knee joint score, and the occurrence of complications were investigated. Results All the 14 patients successfully completed the operation without complications. The average operation time was (3.44±0.85) h. The average amount of bleeding was (352.05±103.68) ml during the operation. The patients received bone healing (X-ray confirmed healing), the healing time was 11-19 weeks, and the average healing time was (14.7±1.6) weeks. Clinical effect:9 cases were excellent, 4 cases were good, the total excellent rate was 92.86%. Until June 30 in 2017, the follow-up times was 12-28 months, the average follow-up time was (18.1±3.9) months. And the average HSS score of the knee joint function was (86.4 ± 3.1) scores. No postoperative complications and follow-up period. Conclusion This study has been operated on the posterior lateral column fracture of tibial plateau by the four-column classification system, which makes the patients get better rehabilitation and limb function recovery.