One hundred fifty-seven patients with Sanders type II and III displaced intraarticular calcaneal fractures were randomized to receive osteosynthesis via either the extensile lateral approach (ELA) (n=81) or the sinus tarsi approach (STA) (n=76). The primary outcome was the incidence of complications. Secondary outcomes included intraoperative radiation exposure, time to fracture union, radiological parameters (Böhler’s and Gissane angles), and functional outcomes (AOFAS score). Outcomes were assessed at least up to one year. Overall, the study found that the STA group had significantly fewer skin complications and lower rates of subtalar osteoarthritis. Additionally, the STA group demonstrated better functional and radiological outcomes. These findings suggest that STA is superior to ELA for managing these fracture types.