Background <p>Tibial plateau fractures are frequently observed in elderly patients, often resulting from low-energy trauma. The treatment of tibial plateau fractures in this population is further complicated by factors such as osteoporosis, osteoarthritis, and other medical comorbidities.</p> Objective <p>This article provides a comprehensive review of the different treatment strategies for proximal tibial fractures in the elderly. A variety of internal and external fixation techniques, medical management as well as acute arthroplasty, are discussed as potential approaches for achieving optimal reconstruction and functional recovery.</p> What is already known <p>Existing literature emphasizes that osteoporotic bones, characterized by reduced bone density and compromised structural integrity, pose significant challenges to fracture fixation. These factors often diminish the efficacy of fixation devices in proximal tibial fractures, leading to an increased likelihood of fixation failure.</p> Gap in literature <p>While the high failure rates associated with osteoporotic bone fixation are wellrecognized, there is a notable lack of comprehensive studies that integrate biomechanical, biological, and technological advancements to improve fixation outcomes, in proximal tibial fractures. This article aims to address this gap by reviewing current diagnostic approaches and exploring innovative strategies involving advanced materials and regenerative technologies designed to enhance fixation success.</p> Conclusion <p>The management of proximal tibial fractures in the elderly requires a nuanced approach that integrates surgical intervention with medical management. A tailored treatment plan, based on specific fracture characteristics and overall health, is critical to optimizing postoperative functional outcomes. This article emphasizes the importance of a comprehensive, individualized treatment strategy to improve recovery and quality of life for elderly patients suffering from tibial plateau fractures.</p>