Objective: To evaluate the outcomes of the application of intraoperative percutaneous traction using an external fixator for the reduction of medial wall shortening and misalignment in calcaneal fractures. Methods: From December 2011 to December 2013, 23 Sanders type III or type IV calcaneal fractures with medial wall shortening and misalignment in 22 patients were reduced with open reduction and internal fixation combined with intraoperative percutaneous traction. Bohler’s angle, Gissane’s angle, calcaneal height and calcaneal width were measured before surgery, after reduction with common technique and after reduction with the external fixator, respectively. At every follow-up visit, clinical outcomes were evaluated by the Maryland Foot Score. Results: Bohler’s angle, Gissane’s angle, calcaneal height and calcaneal width were improved after reduction with common technique (P < 0.05). Whereas, reduction with the external fixator improved Bohler’s angle, Gissane’s angle and calcaneal width further compared with reduction with common technique (P < 0.05). During the follow-up period, associate soft tissue-related complications were observed in one case. At the final follow-up visit, clinical outcomes of eleven of thirteen Sanders type III fractures (84.62%) and eight of ten Sanders type IV fractures (80%) were considered excellent or good according to the Maryland Foot Score. Conclusion: Intraoperative percutaneous traction using an external fixator represents a safe and effective method for the reduction of medial wall shortening and misalignment that cannot be well reduced through the lateral approach. The combined use of intraoperative percutaneous traction and open reduction and internal fixation through the extended lateral approach for complex displaced intra-articular calcaneal fractures ensures desirable clinical outcomes. © 2016, E-Century Publishing Corporation. All rights reserved.