Background: The surface of the tibial plateau frequently collapses and pieces are displaced in complex tibial plateau fractures, which are primarily brought on by high-energy accidents. For difficult proximal tibial fractures, the Ilizarov approach combines biological fixation with indirect fracture reduction to produce good results. The aim of this study is evaluation of management of complex tibial plateau fractures by using Ilizarov external fixator with or without minimal internal fixation technique regarding clinical and radiological outcomes. Methods: This prospective cohort study was conducted on 19 patients (94.74% male, female 5.26%), with an average age of 41.11±12.18 years, lesions were more commonly located on the right side, with 11 cases (57.89%), compared to 9 cases (47.37%) on the left. The majority of the lesions were closed, observed in 12 cases (63.16%), while open lesions were found in 7 cases (36.84%), who were managed with minimally invasive Ilizarov external fixator with or without minimal internal fixation technique with mean follow up 2 years. Results: Surgery duration averaged 110.53±42.49 minutes. The average device duration post-surgery was 4.53±0.94 months. Time to union averaged 5.11±1.02 months. Non-union and malunion occurred in 5.26% of cases. Pin tract infections were relatively common, affecting 9 cases (47.37%). Stiffness was observed in 7 cases (36.84%). Conclusion: the use of the Ilizarov external fixator, with or without minimal internal fixation, is an effective method for managing complex tibial plateau fractures, resulting in significant improvements in both clinical and radiological outcomes.