Background: Complex tibial plateau fractures are severe intra-articular injuries characterized by articular comminution, metaphyseal instability and soft tissue compromise, making surgical management challenging. Ilizarov technique offers stable fixation while preserving fracture biology and minimizing soft tissue trauma. This study aimed to evaluate the radiological and functional outcomes of Schatzker type V and VI tibial plateau fractures managed with Ilizarov external fixation. Methods: This prospective observational study was conducted at the National Institute of Traumatology & Orthopaedic Rehabilitation (NITOR) and in a private hospital in Dhaka, Bangladesh, from January 2018 to December 2024. Thirty adult patients with Schatzker type V or VI tibial plateau fractures treated with Ilizarov external fixation were enrolled. Data on demographics, operative parameters, time to union, radiological alignment, functional outcomes and complications were collected prospectively. Functional evaluation was performed using the knee range of motion and the Knee Society Score at 12 months postoperatively. Results: Thirty patients with complex tibial plateau fractures were included in this study. The majority of patients were aged 30–49 years (56.6%) and males predominated (73.3%). Motor bike accident was the most common mechanism of injury (83.3%). All patients underwent Ilizarov external fixation, with 33.3% requiring additional minimal internal fixation. The mean time to fracture union was 16.8 ± 3.5 weeks. Joint stiffness occurred in 10% of patients. Satisfactory radiological alignment was achieved in 90% of patients. The mean knee range of motion was 115.3 ± 14.7° and the mean Knee Society Score was 84.7 ± 10.2. Superficial pin tract infection occurred in 20% of cases, deep infection in 3.3% and loss of reduction in 3.3%. Conclusion: Ilizarov external fixation is an effective and safe option for complex tibial plateau fractures, providing reliable union, good functional outcomes and minimal serious complications.