This review article covers the use of small incision open reduction and internal fixation for the treatment of the intra-articular calcaneal fracture. The central concept is to match the fracture anatomy with the appropriate surgical approach. Covered first is the mechanism and pathoanatomy, which produces a stereotypical pattern. The major components to address include the posterior facet, superomedial fragment, anterolateral fragment, and tuberosity. The choices of approaches discussed are percutaneous, lateral, medial, and combined. A reduction strategy follows that of the extensile approach, and the goal is total anatomic restoration. Fixation consists of small fragment implants, minifragment implants, and K wires. Specific fracture patterns amenable to selective small incision approaches are described. Detailed surgical strategies are provided. These techniques will be placed in the context of pertinent literature on this subject.