Lisfranc fracture-dislocations are complex injuries that require a high skill set from foot and ankle surgeons to diagnose and treat. Conservative treatment is seldom an option for treatment of Lisfranc injuries. The authors believe that even subtle injuries require surgical intervention. The comparison between open reduction internal fixation, partial arthrodesis, and complete arthrodesis is discussed, as well as various fixation techniques to accomplish these procedures when approaching a Lisfranc injury.