: The posteromedial fragment in bicondylar tibial plateau fractures. it's often significant displacement, seems to be under-recognized or recognized and undertreated. The posteromedial approach provides access to the posteromedial and posterior aspects of the proximal tibia, Tibial plateau fractures with a posteromedial fragment (Schz IV, V, and VI) can be effectively managed by the posteromedial approach. Between May 2017 and February 2019, 40 patients with a mean age of 41 years (Range from 21-64 years) with tibial plateau fractures. Patients were diagnosed clinically, checked with standard X-rays; CT was done for all cases. Patients were treated by ORIF through a posteromedial approach with or without additional screws or plate, a screw from a lateral side. Radiological evaluation and functional assessment were done according to the Rasmussen Knee score. Patients were followed-up for an average of 12 months. Union was achieved in all patients with the total Functional Rasmussen Knee score at last follow-up was (Excellent 77.5. %, good 22.5%). The Total Anatomical Rasmussen Knee score at last follow-up was (Excellent 55%, Good 37.5%, Fair 7.5%). Mean Functional Rasmussen Knee score of patients had (Schatzker IV fractures) was Excellent 100%, however, it was Excellent 66.6%, Good 33,3% in those had (Schatzker V fractures) and was Excellent 33,3%, good 66.6 in those had (Schatzker VI fractures). Surgical treatment of tibial plateau fractures through a posteromedial approach that was evaluated in our study can lead to a good functional and anatomical outcome and considered an effective safe approach.