In recent years the treatment of fractures has evolved from extensive open reduction and internal fixation to minimally invasive surgery and biologically benign internal fixation. The ultimate goal of treatment for tibial plateau fractures is to prevent the late development of degenerative osteoarthritis. Surgery is often required to restore joint congruity and alignment, to stabilize the knee, and to allow early joint motion. In most cases, these goals can be achieved through arthroscopic reduction and internal fixation. Arthroscopic reduction and internal fixation offers the advantage of direct visualization of the fracture and its subsequent reduction without a formal arthrotomy or detachment of the anterior horn of the lateral meniscus. Not all types of fractures are amenable to arthroscopic reduction and internal fixation, such as severe bicondylar fractures. This technique is now evolving and some Schatzker Type 6 fractures have been treated with traction on the fracture table, arthroscopy assisted reduction, limited internal fixation of the articular surface, followed by rigid external fixation.