Objective To explore the curative effect of combined anterior and posterior approach in the treatment of complex tibial plateau fractures. Methods A total of 124 patients with tibial plateau fractures admitted to Suzhou Kowloon Hospital Affiliated to School of Medicine, Shanghai Jiaotong University from June 2013 to June 2017 were selected and randomly divided into an experimental group (64 cases receiving routine combined anterior and posterior approach operation) and a control group (60 cases undergoing knee anterior median approach surgery). The clinical efficacy of the two groups was compared. Results All 124 patients were followed up for 18- 37 months with an average of (24 ± 6) months. There were significant differences in the average fracture healing time, incision infection and internal fixation failure between the two groups (P < 0.05). The total score of Merchant scale, daily activities, gait, stability of the knee joint and range of activity were significantly different between the two groups (P < 0.05). Conclusions In surgical treatment of tibial plateau fractures, the combined anterior and posterior approach can shorten the healing time of the fracture, reduce the probability of wound infection and internal fixation failure, but can not relieve the pain. In the postoperative recovery process, the combined approach surgery is superior to the knee anterior median approach surgery.