Abstract: Objective To observe the clinical effect and postoperative incision complications of patients with intra-articular calcaneal fractures by steel plate internal fixation by the tarsal sinus approach combined with vacuum sealing drainage. Methods Total 38 patients with 40 foots with intra-articular calcaneal fractures were admitted in our hospital. All patients aged over 18 years old, and were with closed Sanders Ⅱ, Ⅲ, Ⅳ type intra-articular fracture, without severe soft tissue trauma in ipsilateral ankle, without diabetes and lower extremity vascular disease. All patients were treated with steel plate internal fixation by the tarsal sinus approach combined with vacuum sealing drainage in 4-12 days after injury. We observed the B hler angle, Gissane angle, length of calcaneus, width of calcaneus, height of calcaneus of pre-operation, post-operation and final follow-up, Maryland score of foot at final follow-up, and the postoperative complications. Results All 38 patients were followed up for 12-24 months, the mean follow-up was 15.5 months, the B hler angle, Gissane angle, length of calcaneus, width of calcaneus, and height of calcaneus of post-operation was (32.82±5.77)°, (116.50±8.00)°, (71.05±7.49)mm, (27.64±2.12)mm and (40.31±4.52)mm, respectively, while the final follow-up was (32.27±5.23)°, (115.90±7.80)°, (72.27±6.81)mm, (27.21±2.48)mm and (39.83±4.60)mm, respectively. The excellent and good rate was 80.25%. There was no wound complication. Conclusion With good exposure of the subtalar joint by the tarsal sinus approach, the B hler angle, Gissane angle, length of calcaneus, width of calcaneus and height of calcaneus could be regained. The vacuum sealing drainage can avoid wound infection complications better, reduce the times of change dressing, and alleviate the sufferings of the patient and the burden of clinical doctors.