Objective:To investigate the clinical efficacy of three-column theory in guiding the treatment of complex tibial plateau fractures. Methods:71 patients with tibial plateau comminuted fracture were selected, whose fracture were closed and three column fracture. Patients in the observation group (36 cases) were treated with posterior medial anterolateral approach in line with the principle of three-column theory. Patients in the control group (35 cases) were treated with conventional knee median incision approach. All the curative effect indexes and Rasmussen score at 12 months after operation were compared between the two groups.Results:The mean postoperative weight-bearing time in the observation group was (42.6±8.5)d, which was earlier than that in the control group[(49.9±10.2) d], the difference was statistically significant(P<0.05). The Rasmussen score in the observation group was 16.5±2.5 after 12 months, which was better than that in the control group (12.5±3.1), the difference was statistically significant (P<0.05). However, there was no significant difference in tibial plateau tibial shaft angle (TPA) and posterior slope angle(PA)between the two groups after immediate postoperation and at 12 months after operation (P>0.05).Conclusion:The three-column theoretical classification can effectively guide to formulate surgical programs, which can gain more excellent reduction, more reliable fixation and satisfactory recovery of the knee functions.