Five randomized controlled trials, involving 241 patients with Lisfranc injuries, were included in this systematic review and meta-analysis. Among these, 121 patients underwent primary arthrodesis (PA), and 120 underwent open reduction and internal fixation (ORIF). Pooled outcomes of interest included the American Orthopaedic Foot & Ankle Society (AOFAS) midfoot scores, SF-36 scores, visual analog scale (VAS) pain scores, patient satisfaction, and return to surgery rates. Results showed statistically significant improvements in VAS pain scores, patient satisfaction, and decreased all-cause return to surgery favoring PA. No significant differences were observed for AOFAS midfoot and SF-36 scores. The findings suggest PA may reduce pain and the need for further surgeries compared to ORIF, although the results are limited by significant heterogeneity and small sample sizes.