In a follow-up of an overall 100 cases with proximal, intraarticular tibial fractures the long-term results after surgical treatment were evaluated in a critical analysis over periods of up to 12 years. The rate of postoperative complications as regards wound healing deficiencies and infections was 6% and thus consistent with the complication rates reported in literature. While most cases showed good radiographic postoperative results, poor clinical results in the Lysholm score were seen with 29% of cases at the time of the follow-up. The clinical results showed a highly significant correlation with the type of fracture (p < 0.001). As regards the radiographic long-term results, minor to severe arthrotic changes were seen in 71% of cases. These changes also showed a significant correlation with the type of fracture--as graded by the principles of the AO group. Impressions or formation of overlappings of the affected joint surfaces of up to 5 mm were seen in nearly 50% of cases, while in a further 13% the extent was up to 10mm. These findings correlated well with the complaints about pain on the part of the patients and with the type of primary fracture. The objective of surgical treatment is to provide for an exercise-stable osteosynthesis in order to restore early function of the affected joint. The essential criterion is the extent of soft tissue damage determining the type and the timing of treatment. Arthrosis due to the primary damage of cartilage tissue is to be expected even with sufficient primary surgical management.