Background <p>The treatment of posterolateral tibial plateau fractures(PTPF) is challenging, and 3D printing technology can assist in their management.</p> Objective <p>Comparative efficacy of modified anterolateral approach versus traditional anterolateral approach in open reduction and internal fixation for posterolateral tibial plateau fractures.</p> Methods <p>Forty-seven patients with PTPF treated at the First Affiliated Hospital of Xinjiang Medical University between February 2018 and May 2022 were analyzed. Group A (<i>n</i> = 24) underwent a modified anterolateral approach, and Group B (<i>n</i> = 23) a traditional anterolateral approach. We compared intraoperative blood loss, operative time, fixation method, fracture healing, and complications. Knee function was assessed with the Rasmussen knee score, and radiographic reduction with the Rasmussen radiographic score.</p> Results <p>All 47 patients were followed up for more than one year postsurgery. All fractures achieved satisfactory union, with no vascular injury, nerve injury, or wound infection observed. The mean duration of surgery in Group A was significantly lower than those in Group B. There was a significant difference in the mean Rasmussen function scores between Group A and Group B. The average Rasmussen radiology scores in Group A were significantly greater than those in Group B. No significant difference was found in the mean time required for bone union and amount of intraoperative blood loss between the two groups.</p> Conclusion <p>Integrating 3D printing technology with different surgical approaches for PTPF management shows favorable outcomes and enhances postoperative safety. The modified anterolateral approach leads to reduced exposure time, less blood loss, and better knee function recovery than the traditional approach. It is recommended to use the modified anterolateral approach at the time of treating posterior lateral tibial plateau fractures.</p>