Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 12 2 2026 05 18 96 101 Pranav Kothiyal Associate Professor, Department of Orthopedics, Sri Guru Ram Rai University, Dehradun, India Kunal Vij Professor, Department of Orthopedics, Sri Guru Ram Rai University, Dehradun, India Pranjal Khatri Junior Resident, Department of Orthopedics, Sri Guru Ram Rai University, Dehradun, India 2025 09 25 2026 05 18 Background:  Displaced intra-articular calcaneal fractures (CFs) pose significant challenges in management. This prospective comparative study aimed to evaluate and compare the clinicoradiological and functional outcomes of the sinus tarsi approach (STA) versus the extensile lateral approach (ELA) in Sanders type II and III fractures. Methods: Between February 2022 and August 2024, 120 patients aged 18-65 years with closed displaced intra-articular CFs (Sanders type II/III) were prospectively enrolled and randomly allocated to undergo open reduction and internal fixation (ORIF) via STA or ELA (60 patients each). Outcomes included time to surgery, operative duration, restoration of Böhler’s and Gissane’s angles, complications, and functional scores [American Orthopedic Foot and Ankle Society Score (AOFAS) and Maryland Foot Score (MFS)] at 6, 12, and 24 weeks. Results: The STA group had significantly shorter time to surgery (mean 4 vs. 6 days, P = 0.01) and operative time (65.5 ± 10.2 vs. 85.3 ± 12.4 minutes, P = 0.001). Both approaches achieved good radiological restoration, with ELA showing marginally better postoperative Böhler’s (28.5° ± 3.2° vs. 27.8° ± 3.1°) and Gissane’s (130.2° ± 3.8° vs. 128.5° ± 3.6°, P = 0.001 for Gissane’s) angles. Complication rates were low and comparable. At 24 weeks, STA demonstrated superior AOFAS (91.0 ± 4.9 vs. 90.0 ± 5.5, P = 0.001) and MFS (90.0 ± 4.3 vs. 89.0 ± 5.2, P = 0.001). Conclusion: Both approaches yield satisfactory outcomes, but STA provides advantages in operative efficiency and long-term functional recovery with similar complication rates. STA may be preferred for most Sanders type II and III fractures, reserving ELA for complex cases requiring greater exposure.  https://jost.tums.ac.ir/index.php/jost/article/view/717 https://jost.tums.ac.ir/index.php/jost/article/download/717/470