【Abstract】 Objective To compare the clinical value of of anterior medial approach and posterior inverted L approach for the treatment the treatment of tibial plateau fracture of medial column. Methods The clinical data of 50 medial posterior column fractures of tibial plateau were retrospectively analyzed. According to the surgical approach, the patients were divided into anterior medial approach group and posterior inverted L approach group. All the patients were followed up for 6 months to 1 year. The joint function score, fracture healing time, full weightbearing time, knee joint activity, fracture reduction, joint function recovery rate and patient satisfaction score were observed. Results Fracture healing and complete weightbearing time of posterior inverted L approach group were significantly shorter than that in anterior medial approach group (P<005). No significant difference was detected in the functional scores of the two groups before treatment (P<005). No significant difference was detected between the two groups in the scores of joint function before treatment (P>005). The joint function scores of the two groups were improved after treatment (P<005), and the scores of the joint function score of posterior inverted L approach group were significantly improved (P<005). The excellent rate and satisfaction score of posterior inverted L approach group were significantly higher than that in anterior medial approach group (P<005). The activity of knee joint in posterior inverted L approach group was significantly superior to that of the medial anterior approach group (P<005). Conclusion The posterior approach of inverted Lposterior approach for the treatment of medial posterior column fracture of the tibial plateau has a significant clinical effect. The function of knee joint recovery is better and faster, the patient's satisfaction is higher, which is beneficial to reduce the occurrence of medical disputes, and a treatment of posterior tibial plateau patients with medial column fracture of the preferred treatment.