Background: Among the most common fractures in knee injuries, tibial plateau fractures have been demonstrated to heal better when treated with screws located closer to the joint. This study aimed for comparing the outcomes between the use of bone grafts versus using rafting screws in management of depressed tibial plateau fractures.

Subject & Methods: In our controlled study, a total number of 24 cases with depressed tibial plateau fractures were enrolled, group A: involved 12 cases who were managed using rafting screws and group B: involved 12 cases who were managed without using grafts. Follow up and X ray were done monthly for 2 months then every 2 months for till end of 2 years.

Results: The Visual Analogue Scale (VAS) on 1st day postoperatively showed less pain in group A than group B with p<0.05. After 3 months, VAS returned to be higher in group A than group B with p-value= 0.02, the mean of the operative time was 93.33 minutes in group A (range; 60-180 mins) and 102.5 minutes (range; 90-180 mins) with P= 0.001, Group A had slightly less residual articular depression while group B had slightly higher residual condylar widening, three cases had complications, 1 case in group A and 2 cases in group B.

Conclusion: Mild to moderate depression (>1.5 cm) in the tibial plateau can be treated successfully with open reduction and internal fixation utilizing large set buttress plate and screws or screws alone, without the need for bone graft or bone graft substitute