Bone graft substitutes are generally required in tibial plateau fractures. Previous studies have established calcium phosphate as superior to autogenous iliac crest bone graft (AIBG), at least in terms of subsidence. The authors in this study randomized 137 patients with AO 41-B2 and 41-B3 fractures to receiver either AIBG or a hydroxyapatite/calcium sulfate cement. Outcomes measured were the SF-12 physical and mental component scores (PCS & MCS), pain on visual analogue scale, and subsidence on radiography, all measured at 26 weeks post-operatively. The calcium bone substitute was non-inferior in terms of SF12 PCS, MCS, subsidence, and pain score. There was significantly less blood loss in the calcium bone substitute group, and a trend towards shorter duration of surgery.