Surgical Treatment of Calcaneal Fractures by Minimally Invasive Technique Using a 2-Point Distractor Versus ORIF and Conservative Therapy—A Retrospective Multicenter Study

<b>Background:</b> The management of intra-articular displaced calcaneal fractures remains controversial. Both minimally invasive technique (MIT) and open reduction internal fixation (ORIF) are commonly employed, but there is no clear consensus on the optimal approach. Open surgical techniques carry a higher risk of wound complications, whereas percutaneous methods may offer less precise fracture reduction, while conservative therapy (CT) shows higher functional complications. The aim of this retrospective study was to compare the radiological and functional outcomes of three treatment methods for calcaneal fractures. <b>Methods:</b> Patients admitted to two level-one trauma centers between 2013 and 2023 were analyzed. Clinical and radiological parameters and scores were collected. The outcome measures were assessed using Böhler's and Gissane's angles. The clinical results were compared using the Visual Analogue Scale (VAS), the American Orthopaedic Foot and Ankle Society Hindfoot Score (AOFAS), the Maryland Foot Score (MFS), and the Parker Mobility Score (PMS) at the 12-month follow-up. <b>Results:</b> A total of 236 patients with 256 calcaneal fractures were analyzed. Among them, 175 men and 61 women were included. The mean patient age was 46.3 (min-max) years. In total, 130 patients were treated operatively (minimally invasive technique or ORIF), and 106 were treated conservatively. Böhler's and Gissane's angles at follow-up were significantly higher within the operated group. Complications occurred more frequently in the surgical treatment group than in the conservative treatment group, especially deep infections within ORIF (<i>p</i> < 0.001). MFS and VAS yielded better results for surgical treatment. <b>Conclusions:</b> Based on the results of this study, surgical treatment is preferable to conservative treatment due to better anatomical reduction and a slightly better functional outcome. One-year results for all three methods were comparable, showing good clinical and functional results with the surgical groups.