Abstract:[Objective] To compare the clinical outcome of closed reduction and percutaneous three-dimensional cannulated screw fix-ation (PTDCSF) versus open reduction and plate fixation (ORPF) in the treatment of Sanders type II and III calcaneal fractures. [Methods]A retrospective research was done on 99 patients who received surgical treatment for Sanders type II and III calcaneal fractures in our hospi-tal from December 2019 to December 2021. According to the doctor-patient communication before surgery, 51 patients received PTDCSF,while other 48 patients had ORPF performed. The documents regarding to perioperative period, follow-up and imaging were compared be-tween the two groups. [Results] The PTDCSF group was significantly superior to the ORPF group in terms of surgery time [(50.2±1.8) minvs (87.6±1.8) min, P＜0.001], incision length [(3.1±0.5) cm vs (14.3±0.4) cm, P＜0.001], blood loss [(15.0±1.8) mL vs (164.9±1.8) mL, P＜0.001], hospital stay [(4.0±0.2) days vs (9.9±0.2) days, P＜0.001]. However, the former had significantly greater intraoperative fluoroscopytimes than the latter [(17.1±1.9) times vs (4.9±1.8) times, P＜0.001]. In addition, the PTDCSF group resumed postoperative ambulation andfull weight-bearing activity significantly earlier than the ORPF group (P＜0.05). The VAS, AOFAS score and inversion-eversion range ofmotion (ROM) in both groups were significantly improved over time (P＜0.05). The PTDCSF group was also significantly better than the OR-PF group regarding VAS score [(2.9±0.8) vs (5.8±1.1), P＜0.001; (0.9±1.0) vs (2.0±1.0), P＜0.001], AOFAS ankle and hindfoot score [(63.4±2.9) vs (60.6±2.6), P＜0.001; (94.9±2.2) vs (91.1±2.5), P＜0.001] and ROM [(15.4±0.6)° vs (11.7±0.7)°, P＜0.001; (54.6±1.8)° vs (51.5±1.6)°,P＜0.001] 3 days after surgery and at the last follow-up. As for imaging, the B?hler angle, Gissane angle, cartilage surface collapse, calcane-us length, calcaneus width and calcaneus height were significantly improved in both groups at the last follow-up compared with those preop-eratively (P＜0.05). Although there was no statistical significance in calcaneus length between the two groups at the last follow-up (P＞0.05),the remaining radiographic items in the PTDCSF group were also significantly better than those in the ORPF group at the latest follow-up(P＜0.05). [Conclusion] Percutaneous three-dimensional cannulated screw fixation is multidimensional intraosseous fixation, with orienta-tion of the screws based on the stress distribution of calcaneus. Therefore it is more consistent with the biomechanical characteristics of cal-caneus, and does effectively fix fracture, and maintain the position and shape of the bone, with higher safety.