Historically, intra-articular calcaneal fractures have been managed, as a rule, nonsurgically, although surgical treatment has more advocates in the past 20 years. Even today many high specialized orthopedic surgeons have a lot of controversies relating the indications fields of nonsurgical and operative treatment of these fractures. For getting correct decision adequate preoperative evaluation of fracture type, overall patients health and his Generally, elderly patients with sedentary habits, without or with minimal fracture displacement, might be treated successfully with nonsurgical management. Good result after surgical treatment might be predicted in patients younger than 40 years, with a simple fracture pattern and high probability of achieving anatomic reduction. Highly precise and good surgical technique is necessary for getting a good final result with a long learning curve of the surgeon. Smoking, diabetes, chronic medical illness, peripheral vascular disease as well workers compensation claim (!) markedly increase the risk of surgical complications.