Objective To compare the clinical effect of temporary external fixation and calcaneus traction prior to the internal fixation of complex tibial plateau fractures.Methods A total of 104 patients with complex tibial plateau fractures admitted to our hospital from January to December 2020 were selected and divided into external fixation group (55 cases) and traction group (49 cases). Both groups were treated with internal fixation of complex tibial plateau fractures. Before the internal fixation, the external fixation group was treated with external fixators, while the traction group was treated with calcaneus traction. The stime from admission to internal fixation, operative duration, length of hospital stay postoperative, complication rate, operative outcome and follow-up indicators were compared between the groups.Results The time from admission to internal fixation, operative duration, and length of hospital stay were shorter, and the amount of intraoperative bleeding was smaller in the external fixation group relative to the traction group (P < 0.05). The overall incidence of postoperative complications in the external fixation group was lower than that in the traction group (P < 0.05). The excellent and good rate of external fixation group was higher than that of traction group (P < 0.05). During the outpatient follow-up, the fracture healing time was shorter, the range of motion of the knee joint was greater, and Hospital for Special Surgery (HSS) score was higher in the external fixation group compared with the traction group (P < 0.05).Conclusions For patients with complex tibial plateau fractures, temporary external fixation prior to internal fixation can further improve the operative outcome and patient safety, reduce the preoperative waiting time and operative duration, promote the fracture healing and contribute to good prognosis, and it could be therefore recommended in clinical practice.