31 patients with Sanders type IV displaced intra-articular calcaneal fractures were randomized to compare the efficacy of open reduction and internal fixation (ORIF), and primary subtalar fusion (PSF), over 2-7 years. Patients were assessed using the Short Form-36 version 2 (SF-36); the Musculoskeletal Function Assessment Survey (MFA); the American Orthopaedic Foot & Ankle Society’s Ankle-Hindfoot Scale (AHS); and the visual analog scale (VAS). The evidence presented in this study demonstrates that the two interventions are comparable for the long-term health outcomes of Sanders type IV displaced intra-articular calcaneal fracture treatment.