[Objective] To explore the strategy and outcome of 3D printing assistance and Frosch approach for open reduction and in-ternal fixation (ORIF) of posterolateral tibial plateau fractures. [Methods] A retrospective study was performed on 43 patients who receivedORIF for posterolateral tibial plateau fractures in our hospital from January 2021 to February 2022. According to the preoperative doctorpatientcommunication, 21 patients were treated with ORIF of 3D printing assistance and Frosch approach (Frosch group), while the re-mained 22 patients received ORIF via the anterolateral combined posterolateral Carlson approach (AP groups). The documents regarding toperioperative period, follow-up and images were compared between the two groups. [Results] All patients in both groups had correspondingsurgical procedures performed successfully, without significant differences in terms of operation time, total incision length, intraoperativeblood loss, intraoperative fluoroscopy times, hospital stay between the two groups (P＞0.05). However, the Frosch group resumed walking sig-nificantly earlier than the AP group [(8.4±0.3) days vs (14.5±0.3) days, P＜0.001]. Compared with those 3 months after surgery, the VASscore for knee pain, HSS score and knee extension-flexion ROM were significantly improved in both groups at the last follow-up (P＜0.05).The Frosch group proved significantly superior to the AP group in terms of VAS [(2.2±1.1) vs (3.9±1.7), P=0.039] 3 months after surgery,[(0.9±0.7) vs (1.8±1.4), P＜0.001] at the last follow-up; HSS score [(62.5±6.2) vs (58.1±6.3), P=0.026] 3 months postoperatively, [(88.8±7.5)vs (81.6±9.2), P=0.007] at the latest follow-up; the knee ROM [(91.7±3.2)° vs (87.6±3.8)°, P＜0.001] 3 months postoperatively, [(120.6±4.3)° vs (116.9±3.5)°, P=0.003] at the final interview. [Conclusion] The 3D printing assistance combined with Frosch approach can explorethe posterolateral tibial plateau fracture directly to facilitate effective reduction of the articular surface and placement of internal fixation im-plants, reduce operative complications, regain ambulation early, and achieve better functional recovery.