Tibial plateau fractures with compression of the joint surface usually require surgical treatment to restore the joint surface. As far as possible, we always use an arthroscopically assisted technique with minimally invasive screw fixation. If the joint surface is more severely compressed, autologous cancellous bone is removed from the iliac crest (iliac crest cancellous bone) and relined under the joint surface. In these cases, plating is regularly required.