Conservative management of considerably displaced tibial head fractures tends to stretch the ligaments and damage the soft tissue. Plateau steps impair mobility and lead to secondary osteoarthritis. Therefore operative procedures are prefered: A buttressing plate supports the displaced condyle after exposure and immaculate reduction. Impacted fragments call for elevation and underlining by cancellous graft. Postoperatively, early active motion and late weight bearing is the rule. Operative procedures will only produce satisfactory results when performed by an experienced surgeon.