Calcaneal fractures are complex, intra-articular injuries that significantly impair mobility and quality of life. Calcaneal fractures, especially displaced intraarticular variants (Sanders II-IV), pose challenging management issues due to their complexity and impact on hindfoot function. Standard operative management using the extensile lateral approach offers excellent visualization and reduction but often requires sectioning the calcaneofibular ligament (CFL) to access the posterior facet. Traditionally, ligament is cut at its insertion and repaired as a soft tissue structure; however, this is less robust than anatomical bone-to-bone healing and may limit restoration of native biomechanics.

Bone-to-bone healing, wherein the CFL is osteotomized with a bone fragment and reattached, is biologically superior to purely ligament-bone repair and is hypothesized to restore both biomechanical integrity and proprioception more completely. Literature shows CFL repair improves postoperative ankle stability but past studies have not employed bone-to-bone methods. This study aims to provide first-of-its-kind comparative data on functional  and detailed radiological outcomes between CFL repaired and unrepaired groups.