Background: Thirty-two displaced intra-articular fractures of the calcaneus in 30 patients were treated with open reduction and internal fixation. Fracture classification was based on Sanders computed tomographic classification. There were 18 type 11 fractures, 10 type III fractures, and 4 type IV fractures. Methods The operations were performed using a standard extended lateral approach, and the fractures were fixed with small-fragment AO T-plates without bone grafting. Average follow-up was 35.4 months (range, 24-53 months). The Creighton-Nebraska Health Foundation Assessment score for fractures of the calcaneus was used for evaluation. Results: The average score was 86.7 for type H, 82.3 for type III, and 59.2 for type IV fractures. There was a clear statistically significant superiority with type H and type III fractures treated with open reduction when compared with type IV fractures (p < 0.0001). Conclusion:On the basis of our result, we recommend that type 11 and type Ell fractures be treated with open reduction and internal fixation. Despite the results of type IV fractures being significantly worse than that of type 11 and type III fractures, we recommend open reduction and internal fixation for type IV fractures to restore the hindfoot architecture and the subtalar joint, if possible. When the disrupted subtalar joint is so comminuted that it is beyond the surgeon's ability to reconstruct, primary subtalar arthrodesis should be performed in addition to open reduction and internal fixation.