This study investigates fractures of the tibial plateau resulting from downhill skiing accidents over a 19-year period ending in 1991 at a moderate-sized ski area in northern Vermont. Thirty-nine skiers who suffered tibial plateau fractures were compared with other injured skiers who sustained 11 357 injuries and 2190 noninjured controls over the same time period. Twenty-nine of the 39 tibial plateau fracture cases were used in statistical analysis and most comparisons. Other injury groups included all other injuries, other tibia fractures, and third-degree medial collateral ligament sprains. Compared with the control population, no significant differences were seen in skier height, weight, ability, number of previous skiing injuries, type of trails skied, normal downhill skiing speed, and age of bindings. However, skiers sustaining tibial plateau fractures were more likely to be older, female, fall less often, more experienced, and more likely to have a binding release at some point during their injury event. The mechanism of the lateral fracture pattern seen in 82%of cases in this study appears to be hyperextension and valgus forces.