Abstract: Objective To evaluate the clinical effect of combing the four column classification theory with minimally invasive percutaneous plate osteosynthesis (MIPPO) technique and anti-osteoporosis in the treatment of senile tibial plateau fractures. Methods From January, 2014 to August, 2015, sixty patients with tibial plateau fractures in our hospital were enrolled and randomly divided into two groups (n=30). The control group received the open reduction and internal fixation, while the research group received four column classification theory and MIPPO technique. Anti-osteoporosis and infection treatment were used during the peroperative period. The tibial plateau angle, posterior tibial plateau angle, femoral tibial angle, knee joint, incision length, intra operative hemorrhage, fracture healing, bone density improvement, visual analogue scale, knee joint function score, complication rate so on operation index were compared between the two groups. Results The knee joint (119.36±6.47) °, HSS[(85.39±9.86) scores], fracture healing[(3.12±0.64) months], intra operative hemorrhage[(62.63±9.58) ml], incision length[(5.17±1.89) cm], complication rate (6.7%) in the research group were better than those in the control group, the differences were statistically significant (P<0.05). The differences in TPA, PA and FTA between the two groups were no statistically significant (P>0.05). Conclusion Combing the four column classification theory with MIPPO technique in the treatment of senile tibial plateau fractures had advantages of less trauma, good reduction, stable and durable internal fixation, good joint function recovery and fewer complications. The effect was good, and it was worth popularizing.