14 patients with comminuted tibial plateau fractures were randomized to open reduction and internal fixation with either novel "anatomical" locking plates or standard locking plates. The purpose of this study was to compare perioperative outcomes, as well as clinical and radiographical outcomes at 3- to 12-month follow-up. The results of this trial demonstrated significant between-group differences in perioperative outcomes, with significantly shorter operative time and lower blood loss noted in the novel anatomical plate group compared to the standard plate group. The trial was unable to detect between-group differences in the time to union, radiographic variables, or clinical outcomes up to 12 months after surgery, however, this trial was limited by the number of patients included. Additionally, it should be noted that one of the authors is listed as the inventor of the novel anatomical plates.