32 patients (25 at last follow-up) with acute tarsometatarsal joint fractures or fracture dislocations were randomized to receive primary arthrodesis (PA) or primary open reduction and internal fixation (PORIF). This study evaluated whether the PA procedure produced improved functional outcomes and fewer secondary surgeries. The results at all-time points (3, 6, 12, 24 months) indicated that there were no physical function differences reported for Short Form-36 (SF- 36) and Short Musculoskeletal Function Assessment (SMFA) scores. The PA procedure resulted in fewer planned/unplanned secondary surgeries compared to PORIF.