Background The relative efficacy of two treatments (operative treatment and nonoperative treatment) for the displaced intra-articular calcaneal fractures (DIACF) remains uncertain.Object We conducted a meta-analysis to compare the effectiveness of operative and nonoperative treatment in treating patients with DIACF.Methods Databases included Cochrane Library,MEDLINE,EMBAS and Google Scholar were searched.After independent study selection by two authors,data were extracted and collected independently.Comparison were done between operative treatment group and nonoperative treatment group.The method ologic quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS).RevMan 5.3 was used for data analysis.Primary outcome measures were anatomical measures(changes in B(o)hler angle,calcaneal height and width),functional measures(problems with wearing shoes,resuming pre-injury work and residual pain) and complications (including superficial and deep wound infection,skin flap necrosis,neurovascular injury,secondary arthrodesis,reflex sympathetic dystrophy,ostectomy,thromboembolism,and compartment syndromes et al.).Results 18 trials (8RCTs and 10CCTs) including 1467 patients were retrieved.As for anatomical measurements,the overall effect mean difference (MD) of mean B(o)hler angle,calcaneal height and width were 15.39[95% confidence interval (CI) 9.12-21.67],6.55 (95% CI 2.67-10.43) and 7.05(95% CI-7.83-6.27),respectively.In functional me asures,the overall effect MD of AOFAS were 6.23 (95% CI 5.22-17.67) and 0.38 (95% CI 0.22-0.67).The overall effect relative risk (RR)of wearing shoes,resuming pre-injury work and residual pain were 0.32 (95% CI 0.32-1.00),0.56 (95% CI 0.40-0.77) and 0.90 (95% CI 0.68-1.20),respectively.The overall effect relative risk (RR)of the incidence of complications were 2.00 (95% CI 1.51-2.64).Conclusion Operative treatment for DIACF may lead to a higher incidence of complications but had better anatomical recovery compared with nonoperative treatment.