[Objective] To compare the clinical effects of open reduction and internal fixation (ORIF) through tarsal sinus approach (TSA) versus L-shaped approach (LSA) for Sanders type Ⅱ and Ⅲ calcaneal fractures. [Methods] A retrospective study was conducted on 80 patients who underwent ORIF for calcaneal fractures in our department from January 2018 to October 2020. According to doctor-patient communication, 38 patients had ORIF performed by TSA, while the remaining 42 patients were by LSA. The perioperative, follow-up and imaging data were compared between the two groups. [Results] All the patients in both groups were operated on successfully without seri- ous complications such as neurovascular injuries. The TSA group proved significantly superior to LSA in terms of incision length, intraoper- ative blood loss, incision healing grade, walking time on the ground and hospital stay (P＜0.05). All the patients in both groups were fol- lowed up for (22.7±7.6) months on an average, and the TSA group resumed full weight-bearing activity significantly earlier than the LSA group (P＜0.05). The VAS score significantly decreased (P＜0.05), while the AOFAS score, varus and valgus range of motion of the foot sig- nificantly increased (P＜0.05) in both groups over time. At 1 month, 6 months postoperatively and the latest follow-up, the TSA group was significantly superior to the LSA group in terms of VAS and AOFAS scores (P＜0.05). Radiographically, the Bohler angle and Gissane an- gle were significantly improved postoperatively compared with those preoperatively in both groups (P＜0.05), whereas which were not statisti- cally significant between the two groups at any corresponding time points (P＞0.05). [Conclusion] The tarsal sinus approach for open reduc- tion and internal fixation of Sanders type Ⅱ and Ⅲ calcaneal fractures has the advantages of minimizing surgical trauma and improving functional recovery over the traditional L-shaped approach.