Proximal tibia fractures, resulting from various trauma types, pose significant clinical challenges due to their complexity and potential complications. These fractures constitute about 1% of all fractures, with a higher incidence in men due to high-energy impacts like motor vehicle accidents, while elderly patients more frequently experience these fractures from low-energy incidents like falls. Effective management of proximal tibia fractures necessitates a thorough understanding of the surgical anatomy. The tibial plateau, divided into medial and lateral sections by an intercondylar eminence, shows different fracture patterns based on the force applied. High-energy trauma often leads to comminuted fractures with extensive soft tissue and neurovascular damage, whereas low-energy impacts typically result in depression-type fractures. Various classification systems have been described over the years that are essential for detailed fracture analysis and surgical planning. Imaging modalities like X-rays, CT scans, and MRIs are crucial for diagnosing and categorizing these fractures, with CT scans providing a comprehensive understanding of complex injury patterns. Soft tissue injuries frequently accompany proximal tibia fractures, commonly affecting the menisci, collaterals, and anterior cruciate ligament, apart from varying grades of injury to the soft tissue cover. Surgical intervention focuses on restoring the proximal tibia’s structure and function, with various approaches tailored to specific fracture types and locations. Careful planning and execution are required to minimize complications and ensure optimal outcomes. This chapter underscores the necessity of a comprehensive understanding of proximal tibia anatomy, precise fracture classification, and appropriate surgical techniques to manage these complex injuries effectively. Addressing both bony and soft tissue components is crucial for improving functional outcomes and reducing long-term complications in patients with proximal tibia fractures.