Background: Tibial plateau fractures involve a major weight-bearing joint. They occur due to a combination of axial loading and varus/valgus applied forces leading to articular depression, malalignment and an increased risk of post-traumatic osteoarthritis. Objective: To evaluate the clinical, radiographic and functional results in a cohort of patients who sustained open reduction and internal fixation by rafting screws 3.5- 6.5mm cortical screws. Patients and methods: A total number of 30 cases were included in this study and divided into 2 equel groups: Group (A) and group (B). The demographic data showed sex distribution as 22 males & 8 females with closed lateral tibial plateau fractures (18 type II & 12 type III). As regard to radiological outcome, there was no significant difference between both groups during the period between December 2019 and November 2020 at Al-Hussein University Hospital. Results: Functional and radiological results without using graft were slightly lesser than when graft was used, but it avoided possible donor site complications of the graft, decreased blood loss and minimized operative time. Conclusion: Treating depressed tibial plateau fractures type II and type III with mild or moderate depression (<1.5cm) by open reduction and internal fixation using large set buttress plate and screws or screws alone without using bone graft or bone graft substitute represented a viable option.