167 patients with displaced intra-articular calcaneal fractures were randomized to surgery using either a minimally invasive longitudinal approach (MILA) or sinus tarsi approach (STA). The purpose was to compare functional and radiographic outcomes, as well as the incidence of complications. In Sanders type II and III fractures, the MILA was associated with similar functional and radiographic outcomes to that achieved with STA. However, STA was associated with better outcome in Sanders type IV fractures. Overall, the incidence of wound-healing complications was lower with MILA.