Schatzker Type VI fractures are complex tibial plateau injuries characterised by multiple fracture lines and complete separation between the plateau and the shaft. These features reduce the effectiveness of standard commercial fixation plates, which often fail to conform to irregular anatomy. Patient-specific plates, tailored to individual bone geometry, offer improved anatomical fit and fixation. This study compares two patient-specific designs based on 3D reconstruction (3DP) and generative design (GDP) with a conventional commercial plate (CP). To enable rapid and cost-effective evaluation, all designs were first prototyped in PLA using fused deposition modelling (FDM). In bending tests, both 3DP and GDP were significantly stiffer than CP, with stiffness increases of 23.8% and 10.0%, respectively. In biomechanical compression tests, both patient-specific designs achieved approximately 15% lower displacement than CP under a 750 N load. Based on these results, the GDP design was selected for metal additive manufacturing using laser powder bed fusion (LPBF). The metal-printed MGDP was tested under a compressive load of 750 N and showed a mean displacement of 2.11 ± 0.01 mm, remaining below the commonly accepted clinical threshold of 3 mm. This work highlights the potential of combining PLA-based prototyping with targeted metal validation to support surgical decision-making and streamline implant development.