Objective: To study the clinic effect of the lateral calcaneal T-shaped incision approach combined with locking plate to treat Sanders Ⅳ calcaneal fractures. Methods: From January 2012 to June 2014, 88 cases were collected into our study and were divided into T-shaped incision group and modificated L-shaped incision group.Each group had 44 cases.X-rays were taken in the regular follow-up.The Bhler angle and Gissane angle were measured.The treatment effect was evaluated according to the ankle and hind-foot score of American Orthopaedic Foot and Ankle Socity (AOFAS). Results: The average follow-up period was (14±3.2) months. The recovery of the articular surface reduction and Bler angles and Gissane angles were satisfied. All fractures healed completely. No other internal fixation complications related fracture. There were 3 cases skin necrosis in T-shaped incision group and 4 cases in L-shaped incision group.There were 1 cases subtalar arthritis in T-shaped incision group and 3 cases in L-shaped incision group. According to the ankle and hind-foot score of AOFAS, the excellent and good rate was 87.8% in T-shaped incision group and 78.7% in L-shaped incision group,there were significant differences between the two groups(t=9.3,P<0.05). Conclusion: The lateral calcaneal T-shaped incision approach can expose the fracture fully and restore the anatomy of the calcaneus and reduce the wound complications,combined with locking plates is an effective method to treat Sanders Ⅳ calcaneal fractures.