This randomized clinical trial evaluated the impact of immediate weight-bearing as tolerated on spatiotemporal gait parameters and fall risk in patients undergoing postoperative rehabilitation for tibial plateau fractures. A total of 106 patients who had undergone open reduction and internal fixation (ORIF) for Schatzker I-IV tibial plateau fractures were recruited, with 39 meeting the inclusion criteria and 10 lost to follow-up. Patients were randomly assigned to a non-weight-bearing group (NWB), following a 6-week non-weight-bearing rehabilitation protocol, or a weight-bearing group (WB), allowed immediate weight-bearing. Both groups received the same therapeutic exercise program. Gait parameters were assessed three months post-surgery, including step length, stride length, single stance time, double stance time, step time, stride time, velocity, cadence, stride width, and gait and balance scores from Tinetti Performance Oriented Mobility Assessment (POMA). Of the 29 patients who completed the study, significant differences in favor of the WB group were observed for affected limb step length (p = 0.010), sound limb step length (p = 0.013), stride length (p = 0.010), affected single limb stance time (p = 0.001), sound single limb stance time (p = 0.007), velocity (p = 0.021), and POMA scores for balance (p = 0.021) and gait (p = 0.002). Immediate weight-bearing as tolerated after ORIF for Schatzker I-IV tibial plateau fractures resulted in improved spatiotemporal gait parameters and reduced fall risk.