Lisfranc injuries, though often subtle, can lead to significant morbidity if not diagnosed and managed appropriately. This chapter provides a comprehensive overview of the fixation of Lisfranc injuries, covering diagnostic strategies, imaging modalities, surgical approaches, and controversies surrounding fixation techniques. Early diagnosis through weight-bearing radiographs, CT, and MRI is essential for detecting ligamentous and osseous injuries. Examination under anaesthesia (EUA) is a critical intraoperative tool for assessing midfoot stability. Surgical fixation strategies range from transarticular screws and dorsal plating to emerging techniques such as suture-button constructs, each with distinct advantages and drawbacks. The chapter discusses the debate between primary arthrodesis and open reduction internal fixation (ORIF), with recent evidence suggesting superior outcomes for fusion in primarily ligamentous injuries. Proper patient positioning, incision placement, and fixation sequence are outlined in detail to optimize surgical outcomes while minimizing complications such as post-traumatic arthritis and stiffness. Postoperative care, including weight-bearing protocols and rehabilitation, is crucial for optimal functional recovery. While some advocate for routine hardware removal to reduce stiffness, current evidence remains inconclusive. Ultimately, the decision-making process should be individualized, balancing joint preservation with the need for stability. The chapter underscores the evolving nature of Lisfranc injury management and the importance of a tailored approach based on injury severity and patient-specific factors.