Objective: To explore the surgical techniques and clinical efficacy of plate fixation for hyperextension tibial plateau fractures. Methods: A retrospective analysis was conducted on 20 patients with hyperextension tibial plateau fractures who underwent surgery in our hospital from January 2018 to October 2022. The operation time, hospital stay, preoperative and postoperative posterior tibial slope angles, knee function score (HSS), and postoperative complications were recorded. Results: All patients were effectively followed up for at least 6 months, with an average follow-up of 14.6 months. The average operation time was 153 minutes, and the average hospital stay was 18.7 days. The average preoperative posterior tibial slope angle improved from -3.7° to 7.3° postoperatively (P < 0.05), with a statistically significant difference. At the last follow-up, the HSS score was 81.2. One case of incision infection was reported, with no other serious complications. Conclusion: Hyperextension tibial plateau fractures present a significant clinical challenge. Strong fixation with a plate, restoration of the posterior tibial slope angle, and maintenance of knee joint stability provide an effective treatment approach for hyperextension tibial plateau fractures.