High-energy tibial plateau fractures are infrequent and technically demanding to treat especially if those are shearing type, coronal plane, displaced fractures. The most widely used the Schatzker system of classification, [1] (Based on the AP radiograph) is more than likely to miss postero-medial and postero-lateral shear fractures, best visible on the lateral, than the AP radiograph. These fractures have recently been characterised by two studies, highlighting their clinical relevance [2,3] and showing that less invasive surgery and indirect reduction techniques are often inadequate. Hohl described unicondylar coronal plane splitting fractures of the medial tibial plateau, noted that these injuries be considered as fracturedislocations. Connolly and others have suggested that the mechanism involved in this fracture pattern is one of knee flexion, varus, and internal rotation of the medial femoral condyle. [4,5,6] Consistent among these and other authors is that the occurrence of this fragment is relatively unusual and that the use of a posteriorly based exposure with direct fracture visualization, anatomic reduction and absolute stability appears to result in satisfactory outcomes. Though variations of a postero-medial approach been previously described (by Trickey et al and also by Burks et al.,), more recently, Lobenhoffer et al described direct posterior exposure, Wang et al described postero-medial approach and Luo et al. described the approach for the management of posterior bicondylar tibial plateau fractures. [7,8] These approaches have been used in isolation or as a dual-incision approach for treating tibial plateau fractures. [9,10,11,12,13,14,15] PURPOSE: The purpose of this study is to describe this unfamiliar direct posterior surgical (Medial Gastrocnemius) approach to a general orthopod, highlighting the relevant anatomy and presenting our experience using this approach in treating a series of 15 patients with complex tibial plateau injuries with associated posterior shear fractures. MATERIALS AND METHODS: This prospective study included 15 cases of patients with mean age of 30 years (Age range 20 to 40 yr) who sustained high velocity posterior tibial plateau fracture-subluxations with or without associated Bicondylar fractures (Duparc, revised classification, Group-V: Postero-medial fracture and its associations). Surgical management includes by direct, dorsal approach and stabilisation with buttress plating and or also postero medial and or antero lateral approach as needed. The patients were followed up at six week, three month, six month and one year postoperatively and assessed using Oxford Knee Score and Lyshom Score. RESULTS: The mean