Forty-three patients with displaced Lisfranc injuries were randomized to receive open reduction and internal fixation (ORIF, n=22) or primary arthrodesis (PA, n=21). The primary outcome was the Visual Analogue Scale Foot and Ankle (VAS-FA) score at 24 months. Secondary outcomes included subscales of the VAS-FA (pain, function, and complaints) and the American Orthopaedic Foot & Ankle Society (AOFAS) Midfoot Scale, assessed at 6, 12, and 24 months. Overall, the results revealed no significant differences in VAS-FA or AOFAS scores between the two groups across all follow-up points. Both ORIF and PA appear to be viable initial surgical methods for displaced Lisfranc injuries. However, the study was underpowered to detect smaller differences, suggesting further research is needed.