A Comparative Study of Operative Versus Non-Operative Management of Closed, Displaced Intra-Articular Fractures of the Calcaneum Characterization Demineralized Bone Matrix and Injectable Platelet Rich Fibrin - A Clinical and Radiographic Study

Abstract

Background: Displaced intra-articular calcaneal fractures (DIACFs) remain challenging injuries, and the optimal management strategy continues to be debated. This study compared the clinical, radiological, and functional outcomes of operative and non-operative treatment.

Methods: A prospective comparative study was conducted between October 2018 and April 2020 involving 60 displaced intra-articular calcaneal fractures in 58 patients. Thirty fractures underwent operative management (open reduction and internal fixation or minimally invasive screw fixation), while 30 received conservative treatment. Functional outcome was assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score. Radiological parameters, fracture union, and complications were compared.

Results: The mean AOFAS score was significantly higher in the operative group than in the non-operative group (84.2 ± 7.75 vs. 79.4 ± 9.04; p=0.016). Operative treatment achieved superior restoration of Böhler's angle (21.06° vs. 17.50°; p=0.0012) and Gissane's angle (134.96° vs. 140.20°; p=0.0015). Time to radiological union was comparable between groups (10.1 ± 2.13 vs. 10.6 ± 2.38 weeks; p=0.33). Persistent heel pain and early subtalar arthritis were more frequent following conservative treatment, whereas wound complications and implant-related problems occurred only after surgery.

Conclusions: Operative management of displaced intra-articular calcaneal fractures provides superior functional recovery and anatomical restoration compared with conservative treatment without significantly affecting fracture union time. Although surgery carries procedure-related complications, careful patient selection and appropriate surgical technique can optimize outcomes.