BACKGROUND The surgical strategies for posterolateral tibial plateau fractures are still inconsistent. Although a number of operative approaches were previously reported for surgical treatment of fractures of the posterolateral column in the tibial plateau, some approaches fail to provide direct visualization of the articular surface and do not allow enough space to access the posterolateral area of the lateral tibial plateau, thereby leading to unsatisfactory reconstruction of the knee and poor articular activity. MATERIAL AND METHODS We retrospectively reviewed records of 21 patients who underwent fibular neck osteotomy approach for posterolateral fractures. Radiographs taken during follow-up were used to evaluate the quality of fracture reduction and lower-limb axis. The Tegner-Lysholm score was used to assess patient functional performance. Complications, including incision infection, osteotomy nonunion, peroneal nerve injury, and fragment displacement, were evaluated. RESULTS We included 12 males and 9 females, with an age range of 27-67 years (mean age, 42.43 years). No intraoperative complications or postoperative complications were found. The mean operative duration was 128.05 min (range: 86-167 min). No patients were lost to clinical or radiographic follow-up. All patients had complete follow-up (range: 13-28 months, mean: 19.57 months). Anatomical fracture reduction was achieved in 14 patients. Radiological limb alignment was restored in all patients. The mean Tegner-Lysholm score was 87.07 (range: 74-95) and the average knee society score (KSS) was 91.67 (range: 86-94) at the final follow-up. CONCLUSIONS In this retrospective study, the results suggest that the fibular neck osteotomy approach is a good choice for treatment of posterolateral tibial plateau fractures.