Objective To study the effect of the combined medial and lateral operative approach for the serious intra -articular fractures of calcaneus.Methods The lateral and medial approach for the treatment of the serious intra -articular fractures of calcaneus 22 cases (26 feet),fully exposed in the medial and lateral subtalar joint surface,reduct subtalar joint surface,drill into Kirschner nails for reduction of the calcaneus angle,then graft bones fully in the defect left after reduction,used calcaneus anatomic plate and screws to fix the fracture on the lateral. Results The patients were followed up for 10 -22 months.According to the American Orthopaedic Foot and Ankle association ankle scoring system,the averange score was 87 points.Normal union of 22 feet,4 feet delayed union,skin necrosis no incision,no infections,no cases of neurovascular injury.Conclusion The combined medial and lateral operative approach for the serious intra -articular fractures of calcaneus is an effective method,and can fully expose the lateral and medial fracture,and is conducive to reduction of the lateral and medial articular surface,and restoration of calcaneus shape,reduce malunion and the foot -pain with walking.