Severely comminuted fractures of the lateral tibial plateau with central defects of the articular cartilage have traditionally been treated with iliac crest or patellar autograft, with varying success. Arthrodesis or arthroplasty for late deformity or instability are not suitable for young, active patients. The use of the fibular head as a replacement for the tibial plateau obtained excellent or good functional results in five patients with these difficult fractures.