Objective: To analyze the combined application effects of the joint line incision approach, precise pre-bent plates via three-dimensional reconstruction of the proximal tibia in vitro, and transparent retractors in the clinical treatment of Schatzker types III to VI tibial plateau fractures, and their impact on the functional recovery of the knee joint. Methods: A retrospective analysis was conducted on the surgical treatment outcomes of 28 patients with tibial plateau fractures admitted from January 2023 to January 2025. All patients underwent internal fixation surgery via the joint line incision approach after admission, with the combined use of precise pre-bent plates via three-dimensional reconstruction of the proximal tibia in vitro and transparent retractors for auxiliary treatment during surgery. Surgical treatment indicators, treatment outcomes, and the occurrence of complications were analyzed. Knee joint range of motion and knee joint function scores [New York Special Surgery Hospital Score (HSS), International Knee Documentation Committee Score (IKDC)] were compared before and after surgery. Results: At six months post-surgery, the overall excellent and good reduction rate of tibial plateau fractures in 28 patients was 89.29%. The overall incidence of surgical complications within six months post-surgery was 14.29%, with no cases of severe complications observed. The average surgical duration was 145.32 ± 15.07 minutes, the average intraoperative blood loss was 53.52 ± 6.71 ml, and the average time to fracture healing post-surgery was 14.65 ± 2.21 weeks. Compared to pre-surgery, the range of motion of the knee joint, as well as the HSS and IKDC scores of the knee joint, significantly increased at three and six months post-surgery, with statistically significant differences (P < 0.05). Conclusion: The application of three-dimensional reconstruction-based precise pre-bent plates for the proximal tibia and fluoroscopically visible retractors in internal fixation surgery via a joint line incision approach for patients with Schatzker type III–VI tibial plateau fractures can actively enhance surgical efficiency and the effectiveness of internal fixation. Additionally, it can assist in optimizing postoperative fracture reduction and the rehabilitation of knee joint function in patients.