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To determine the effect of spinal anesthesia (SA) on short-term outcomes when compared with general anesthesia in operatively managed tibial plateau fractures.This is an institutional review board–approved retrospective review of prospectively collected data.Two level-1 trauma centers.One hundred twelve patients with a surgically managed tibial plateau fracture were identified within a registry of patients.Of these, 29 (25.9%) received SA and 83 (74.1%) received general anesthesia in a nonrandomized fashion.Short Musculoskeletal Functional Assessment scores, pain levels, knee range of motion, complications, and reoperations.SA was found to be a predictor of lower pain scores at 3 months (odds ratio, 0.32; 95% confidence interval, 0.12–0.95; P = 0.039) but not at 6 months (P = 0.266) or the latest follow-up (P = 0.056). In the multivariate Short Musculoskeletal Functional Assessment model, although anesthesia type was not found to be a statistically significant predictor, other predictors were identified. Anesthesia type was not a predictor of complications or reoperations. In the univariate analysis, SA was associated with an increased knee range of motion at 3 months (121 vs. 111 degrees; P = 0.048) but not at 6 months (P = 0.31) or the latest follow-up (P = 0.053).In patients who undergo surgical management of a tibial plateau fracture, the use of SA is associated with decreased pain levels in the early postoperative period; however, there was no effect on functional assessment scores.Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.