This study analyzes the cost-effectiveness of the locking plate in grade V tibial plateau fractures in a university hospital. A retrospective study was conducted in patients with Schatzker V tibial plateau fracture. Patients were randomly divided into control (conventional plate, n = 10) and study (locking plate, n = 10) groups. Visual analog scale for pain intensity and WOMAC index were assessed. Total cost of surgery paid by the hospital and the amount paid by the public healthcare system for hospitalization were studied. Among the studied patients, 75% were males, 15% had exposed fracture, 70% used external fixator prior to osteosynthesis, and 10% presented infection. A significant difference in pain intensity was found between the groups (p = 0.0047), with less pain in the study group. WOMAC index was significantly lower in the study group (p = 0.0170). Mean surgery time and mean hospital stay were greater in the control group, but the differences were non-significant (p = 0.2051 and 0.8065, respectively). Total cost of surgery paid by the hospital was lower in the control group. Amount paid by the public healthcare system was higher in the control group. Total cost was lower in the control group. Two of the patients (control group) were reoperated within 30 days of the postoperative period. Thus, total cost of treatment was higher in the control group. Treatment for grade V tibial plateau fractures with a lateral locking plate proved to be more cost effective than treatment with a conventional a double plate and two access points.