Three patients with tibial plateau fractures involving posteromedial fragments were studied. They were treated with a modified fixation method by using small fragment implants placed on the ”borders” of the proximal tibia and a modified anteromedial approach or combined with anterolateral approaches for open reduction and fixation. A minimum follow-up of 7 months was obtained in all patients. All fractures healed within six months without loss of reduction. At the latest follow-up, all patients have excellent functional results and range of motion. There were no infections or soft tissue complications. These results suggest that this technique may have the advantage of anatomic reduction for tibial plateau fractures, especially when the posteromedial condyle is involved.