Background: Lisfranc fracture-dislocation is a devastating trauma affecting usually young active age group, with a high rate of missing or misdiagnosis, resulting in prolonged recovery and significant long-term morbidity. Objective: This study describes the indications, contraindications, technique and results of treating severe Lisfranc fracture-dislocation by 1ry arthrodesis. Methodology: Between 2010 and 2013, 10 patients with closed Lisfranc fracture-dislocation were operated. Mechanism of injury was high velocity injury in 5 patients, fall from a height in 4 patients and 1 patient had a hyperplanterflexion foot trauma during descending stairs. Mean age at time of surgery was 27.7 years (range 19-38 years). All patients were followed up with a follow up period 21.3 months (range 6-36 months). Results: According to the American Orthopedic Foot and Ankle Society (AOFAS) scale was 81.7 (ranging 79-84). Complications met in this study were; 3 patients had a postoperative Sudeck's atrophy, one patient who developed superficial wound problem, and 2 patients had forefoot stiffness and difficulties in shoe wearing. Conclusion: Open reduction and internal fixation of severe Lisfranc fracture-dislocation with screws and primary arthrodesis is the treatment of choice, as those fracture-dislocations are known with their affinity for posttraumatic arthritis and subsequent need for a second operation. Level of evidence: case series type IV. Key words: Lisfranc, fracture-dislocation, midfoot injuries, tarsometatarsal.