What this means for my practice?

Both ORIF and PA are viable initial surgical options for displaced Lisfranc injuries, demonstrating comparable functional outcomes at 24 months. However, clinicians should be mindful of the higher complication rates associated with ORIF, particularly the increased likelihood of screw removal. Despite these findings, the study's underpowered design due to recruitment challenges limits the robustness of its conclusions. In clinical practice, both techniques are reasonable, but the choice of treatment should be individualized based on patient characteristics and preferences. The study's small sample size and underpowered nature highlight the need for further research to detect potential smaller differences between these treatment options.