〔Abstract〕 Objective For patients with complex tibial plateau fractures, unilateral and bilateral plate internal fixation were used for treatment, and the prognosis was explored. Methods A retrospective study was conducted on 112 patients with complex tibial plateau fractures who were treated at the Affiliated People’s Hospital of Quanzhou Medical College from January 2012 to December 2020. 56 patients underwent unilateral plate internal fixation were grouped as the control group, and 56 patients underwent bilateral plate internal fixation as the observation group. The treatment efficacy, surgical indicators, knee range of motion (ROM), and knee function scores of the American Hospital of Special Surgery (HSS) were compared between the two groups of patients, and the complications of the two groups were counted. Results The total effective rate of treatment in the observation group was 96.43%, which was significantly higher than 85.71% in the control group. The difference was statistically significant (P < 0.05). The operation time, fracture healing time, and hospitalization time of the observation group were shorter than those of the control group, and the amount of intraoperative blood loss was less than that of the control group. The difference was statistically significant (P < 0.05). The incidence of complications in the observation group was 5.36%, which was lower than 17.86% in the control group, and the difference was statistically significant (P < 0.05). At 6 months after operation, the knee ROM angle of the observation group was greater than that of the control group, and the HSS knee function score was higher than that of the control group, the difference was statistically significant (P < 0.05). Conclusion Bilateral plate internal fixation for patients with complex tibial plateau fractures has a significant therapeutic effect, which can shorten hospitalization time, reduce intraoperative blood loss, reduce complications, and can effectively improve knee joint function.