Fracture dislocations of the knee involving the proximal tibia are difficult to treat because of the operative approach that maybe required and the instability of the construct. This paper evaluates the use of a two-incision approach with a medial double-plating technique. The clinical results of a case series of 42 patients collected prospectively are presented. At final follow-up 37 out of 42 (88%) had satisfactory reduction of the articular surface and 41 (98%) had satisfactory alignment. At one year postoperation there was no loss in reduction or alignment. The mean HSS score was 90.9 (s.d. 3.35, range 83 to 97). There were no superficial or deep infections, however four cases (10%) had a sanguinous effusion for more than one week postoperatively. It was concluded that the medial double-plating operation is an effective way of managing fracture dislocations involving the proximal tibia.