BACKGROUND: Pediatric tibial plateau fractures are rare injuries. Improved adult tibial plateau fracture management has been made possible due to the introduction of external fixators and locked fixation devices. This has not been reported in pediatric literature. METHODS: Between 2005 and 2011, our institution has surgically treated 13 pediatric tibial plateau fracture patients. Mean age at the time of injury/surgery was 14.0 years (range 9-18 years). There were 11 boys and 2 girls. There were 8 S-H IV fractures and 5 S-H III fractures. Preoperatively, radiographs and CT scans were obtained. A temporary spanning external fixation was used for soft-tissue resuscitation prior to definitive fracture reconstruction. Double plating was used in fractures with a displaced coronal split component of the posterior aspect of the medial tibial plateau. Clinical and radiographic data, including fracture pattern, changes in alignment, local and systemic complications, hardware failure, and fracture union were analyzed. Knee osteoarthritis outcomes scores (KOOS) were collected at the last follow-up. RESULTS: Mean follow-up for the 13 patients was 13.32 months (range 6-48). Two patients received fasciotomy for compartment syndrome and both had skin grafting for final wound closure. Six lateral meniscus lacerations were found in surgery and repaired. There were two deep MCL ruptures and one ACL detachment that were also repaired. Locked proximal tibial plate was used in 8 out of 13 cases. All fractures progressed to union at a mean of 2.5 (range, 2-3.5) months. KOOS subscales averages were: pain (89), symptoms (85), ADL (90), sport/rec (75), and QOL (78). CONCLUSIONS: Spanning external fixator and locked fixation device provided stable fixation of pediatric tibial plateau fractures with a low complication rate. This is the first study showing successful surgical management of pediatric tibial plateau fracture management with locked device fixation and good outcome. It also highlights the high incidence of meniscus and collateral ligament injury in this special population.