Abstract: Objective To explore the clinical effect of ultrasound-guided closed reduction and internal fixation in the treatment of children with calcaneal fracture. Methods A retrospective case-control study was conducted to analyze 100 children with calcaneal fracture admitted to our hospital from January 2020 to August 2022, all of whom received internal fixation with closed pry reduction and Kirscher needle. Among them, 55 cases were operated under ultrasound guidance (the ultrasound group) and 45 cases were operated under fluoroscopy (the fluoroscopy group). The perioperative, follow-up and imaging data of the two groups were compared. Results The operative time, intraoperative fluoroscopy times, intraoperative blood loss, walking time and hospital stay in the ultrasound group were all less than those in the fluoroscopy group (P < 0.05), and there were no complications such as nerve injury and symptomatic thrombosis. The mean follow-up was (17.5±4.5) months, and no adverse events such as loosening of Kirschner's needle or re-surgical revision occurred. As time went on, VAS score of both groups decreased significantly (P < 0.05), while AOFAS score, foot varus and foot varus ROM increased significantly (P < 0.05). At the same time point, there were no statistically significant differences in AOFAS score, foot varus and foot varus ROM between the two groups (P > 0.05). On the imaging, Bohler Angle was significantly increased at 1 month after surgery and at the last follow-up compared with that before surgery (P < 0.05), and Gissane Angle and the collapse height of articular cartilage were significantly decreased compared with that before surgery (P < 0.05). At the same time point, there was no statistically significant difference between the two groups in Bohler Angle and Gissane Angle (P > 0.05). Conclusions Compared with fluoroscopy, ultrasound-guided closed reduction and internal fixation in the treatment of calcaneal fracture in children has the advantages of shorter operation time, less radiation damage and less intraoperative bleeding.