Abstract:[Objective] To evaluate the clinical outcomes of lateral transverse incision used for locking plate fixation of displaced calca- neal fractures in the elderly. [Methods] A retrospective study was done on 42 elderly patients (42 feet) who received open reduction and in- ternal fixation with locking plate for intraarticular calcaneal fractures from January 2015 to June 2021. According to doctor-patient commu- nication preoperatively, lateral transverse incision was used in 21 patients, while the traditional L-shaped incision was used in other 21 pa- tients. The perioperative, follow- up and imaging data of the two groups were compared. [Results] All patients in both groups had corre- sponding surgical procedures performed successfully without serious complications. The transverse group proved significantly superior to the L-shaped group in terms of incision length [(8.5±1.5) cm vs (17.3±1.7) cm, P=0.029], intraoperative blood loss [(72.4±10.5) ml vs (96.8± 11.2) ml, P=0.007], incision healing grade [A/B/C, (19/2/0) vs (14/6/1), P=0.048] and hospital stay [(8.0±4.6) days vs (18.0±4.9) days, P= 0.012]. However, the transverse group got significantly greater times of intraoperative fluoroscopy than the L- shaped group [(13.5±2.5) times vs (5.8 ± 2.3) times, P＜0.001]. There was no significant difference in operation time and time to resume walking between the two groups (P＞0.05). The follow- up period lasted for more than 12 months, and there was no a significant difference in time to resume full weight activity between the two groups (P＞0.05). The VAS score for pain decreased significantly (P＜0.05), while AOFAS score and inver- sion- eversion ROM in both groups increased significantly over time (P＜0.05), which were not statistically significant between the two groups at any time points accordingly (P＞0.05). Radiographically, calcaneus length, Bohler angle and Gissane angle significantly increased (P＜0.05), while calcaneus width significantly decreased (P＜0.05) in both groups at 2 days and the last follow-up after surgery compared with those preoperatively. At the corresponding time points, there were no significant differences in the above image measurements between the two groups (P＞0.05). [Conclusion] Compared with the traditional L-shaped incision, the lateral transverse incision has the advantages of less trauma and fewer complications in open reduction and internal fixation of displaced calcaneal fractures in the elderly.