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OBJECTIVES: To review the long-term functional results of the surgical treatment of tibial plateau fractures using standard techniques of open reduction and internal fixation. DESIGN: Retrospective study. SETTING: University hospital. METHODS: Forty-seven displaced fractures of the tibial plateau in forty-six patients were treated with open reduction, interfragmental screw fixation of the articular fragments, and buttress plate fixation and had a minimum of five years of follow-up. All aspects of their care, including tibial plateau fracture type, operative management and associated injuries, were documented. Preoperative and postoperative follow-up radiographs were analyzed for fracture classification and adequacy of reduction. All patients were contacted and given functional outcome questionnaires using both a generic health status scale (Short Form 36 [SF-36]) (18) and a disability scale relating to knee osteoarthritis (Western Ontario and McMaster Universities Osteoarthritis index [WOMAC]) (1). Data were also collected regarding return to work and sporting activities. Assessment scores were analyzed with respect to age, fracture type and severity, and were compared to standardized age and sex-matched scores for the healthy population. The average age of the patients at the time of injury was forty years and the average follow-up period was 8.3 years. Of the forty-seven fractures studied, twenty-five were classified as Schatzker types I, II, or III, and the remaining twenty-two were types IV, V, or VI (15). All fractures received operative treatment within forty-eight hours and all but five fractures were acceptably reduced. RESULTS: Compared to the standardized SF-36 categorical and aggregate scores, there was no statistically significant difference between the healthy age-matched population and twenty-four of twenty-six of the under-age-forty group regardless of fracture type. With regard to the over-age-forty group, scores statistically similar to the control population were found in only twelve of twenty-one patients. Although there was a large variance in WOMAC scores for all groups resulting in no statistically significant difference being found, a trend toward higher categorical and aggregate scores was seen with increasing age at presentation. There was no correlation between WOMAC scores and fracture type. Multiple-classifications analysis of all data revealed that presentation age was the most significant source of variation with respect to functional outcome. Fracture type had much less influence and adequacy of reduction had no significant influence on outcome, although the group of patients having an inadequate reduction by the authors' criteria was too small in number to reasonably comment upon. CONCLUSIONS: Open reduction and internal fixation is a satisfactory technique for the treatment of displaced fractures of the tibial plateau, particularly for patients younger than forty years.