Comparative analysis of clinicoradiological results in calcaneal fractures: Conservative versus operative management

Objectives: Calcaneal fractures account for approximately 2% of all fractures and present a significant challenge in orthopedic trauma management. Displaced intra-articular fractures are especially complex, necessitating careful evaluation to determine the best treatment strategies. Despite advancements in surgical techniques, debate continues over whether operative intervention yields better outcomes than conservative management. Materials and Methods: This prospective comparative study enrolled 112 patients with calcaneal fractures, dividing them into Group A (conservative treatment) and Group B (operative treatment). Their functional results, radiographic insights, and complication rates between conservative and operative treatments were compared to create an evidence-based strategy for optimal patient care. We analyzed demographic information, radiographic parameters (including Bohler’s and Gissane angles), functional outcome scores (American Orthopaedic Foot and Ankle Society [AOFAS] and modified Rowe score), and complication rates. Results: The operative group demonstrated significantly superior functional outcomes (AOFAS score: 81.65 ± 10.02 vs. 68.53 ± 11.35, P < 0.002; modified Rowe score: 81.47 ± 13.67 vs. 2.65 ± 15.12). For Bohler’s angle, the mean values show a significant increase from pre-operative (15°) to post-operative (32.94°) and pre-cast and post-cast are 16.67° and 18.41°, respectively. For Gissane’s angle, the data show a decrease from pre-operative (139.35°) to postoperative (117.06°), pre-cast and post-cast means being 138.24° and 134.71°, respectively. However, surgical intervention was associated with higher rates of complications, including wound infections (24%) and hardware-related issues. Conclusion: Operative management provides superior anatomical restoration and functional recovery compared to conservative treatment in displaced intra-articular calcaneal fractures. However, the increased risk of complications warrants careful patient selection and optimized perioperative care.