The treatment of intra-articular fractures of os calcis has so far been controversial. For reconstruction of static and dynamic conditions of the foot, complex deformities must be corrected. Besides intra-articular malformation of the talocalcaneal joint that is supposed to lead to posttraumatic arthritis, there are malalignments like lateral displacement, widening and shortening of the heel, depression of talocalcaneal angles and deviation of talocalcaneal or talocuboidal axes. Even if perfect reconstruction of the talocalcaneal joint is not attained, reconstruction of form will provide a better chance for later function. ORIF is therefore superior to conservative techniques. For indication and planning of the procedure fracture analysis including CT is necessary. A lateral approach allows reconstruction and plate fixation of all intra-articular fracture types. For repositioning, temporary lateral external distraction by external fixation is recommended. The operative technique and results are discussed.