Abstract Objective To investigate the choice of surgical methods and its effect on the prognosis of hyperextension tibial plateau fractures.Methods The clinical data of 53 patients with tibial plateau fractures treated in our hospital from January 2016 to January 2021 were studied retrospectively. According to Firoozabadi standard, they were divided into HTPF group and non-HTPF group, HTPF group (19 cases), including 11 males and 8 females; Age 41.59 ± 10.37 years; 13 cases of right knee and 6 cases of left knee; 2 cases of type II, 8 cases of type III, 6 cases of type IV and 3 cases of type V. non-HTPF group (34 cases): including 19 males and 15 females; The age was 40.83 ± 11.98 years; 20 cases of right knee and 14 cases of left knee; 5 cases of type II, 11 cases of type III, 13 cases of type IV and 5 cases of type V. The operation time, bleeding volume, postoperative drainage volume, wound infection and deep venous thrombosis were recorded. Rasmussen imaging score, medial proximal tibial angle (MPTA) and posterior tibial slope (PTA). At 2, 6 and 12 months after operation, the knee society score (KSS) was obtained.Results ① the total incidence of ligament injury in HTPF group was significantly higher than that in non -HTPF group (x2 = 6.399, P = 0.011). Popliteal artery injury occurred in 1 case in HTPF group. ② The operation time and total blood loss in HTPF group were significantly higher than those in non-HTPF group (P < 0.001).③ The follow-up time ranged from 12 to 16 months, with an average of 14.28 ± 1.06 months. The KSS score of HTPF group was significantly lower than that of non-HTPF group at 2 months after operation, but there was no significant difference between the two groups at 6 months after operation and the last follow-up (P > 0.05).④ The fractures of 53 patients were bony healed. The fracture healing time was 12-18 weeks, and there was no internal fixation loosening. At the last follow-up, PTS in non-HTPF group was significantly higher than that in HTPF group (P < 0.001). There was no significant difference in the excellent and good rate of Rasmussen score between the two groups (P > 0.05).Conclusion Hyperextension tibial plateau fracture is occult and complicated with many injuries. The exploration and repair of soft tissue injury while reducing and fixing the fracture is conducive to the recovery of joint function.