Introduction <p>Popliteal artery injury (PAI) associated with proximal tibial fracture (PTF) is rare but limb-threatening, and its morphological characteristics remain poorly defined. This study aimed to investigate the fracture patterns, associated vascular and soft tissue injuries, and clinical outcomes of PTF with PAI.</p> Methods <p>We retrospectively reviewed cases of PTF with PAI treated at a single institution. Based on previous reports and our experience, fractures were classified into isolated medial tibial plateau fracture (IMTPF), hyperextension bicondylar tibial plateau fracture (HBTPF), metaphyseal shearing fracture (MSF), and others. Clinical characteristics, treatment strategies, and outcomes were analyzed.</p> Results <p>Among 336 patients with PTF, nine (2.7%) had associated PAI. Fracture patterns included IMTPF (<i>n</i> = 2), HBTPF (<i>n</i> = 2), MSF (<i>n</i> = 4), and others (<i>n</i> = 1). IMTPF and HBTPF were typically closed injuries associated with traction-induced vascular injury and demonstrated favorable clinical outcomes following timely revascularization and stable fixation. In contrast, MSF was characterized by anterior open wounds and direct vascular injury caused by posterior displacement of the distal fragment. Two MSF cases required soft tissue reconstruction with pedicled gastrocnemius flap, and one case resulted in amputation.</p> Conclusion <p>PTF with PAI is associated with specific fracture patterns that reflect distinct injury mechanisms and clinical courses. Recognition of these patterns, particularly MSF, may facilitate early diagnosis, guide treatment strategies, and improve clinical outcomes.</p>