Tibial plateau fractures are complex intra-articular injuries often associated with significant soft tissue compromise and ligamentous disruption. These fractures exhibit a bimodal distribution—affecting both young, active individuals from high-energy trauma and elderly patients with low-energy, osteoporotic injuries. Proper classification is critical for treatment planning, and contemporary systems now incorporate three-dimensional computed tomography to enhance surgical decision-making and reproducibility. The chapter details both nonoperative and operative management strategies, emphasizing the need to tailor treatment to fracture morphology, patient comorbidities, and soft tissue status. Surgical techniques include open reduction internal fixation (ORIF), arthroscopically assisted fixation, and definitive external fixation, each with distinct indications, benefits, and risks. Associated injuries—such as ligament avulsions and meniscal tears—require concurrent evaluation and often combined management. Timing of surgical intervention is crucial and should follow trauma principles in polytrauma patients. The chapter also highlights rehabilitation protocols promoting early mobilization and weight bearing to optimize outcomes. Despite advances in fixation techniques and classification systems, individualized care remains paramount, especially in complex injuries or elderly patients. Improved imaging, surgical planning, and multidisciplinary approaches have led to better functional outcomes and fewer complications in managing these challenging fractures.