Eight studies (1237 patients) were included in this meta-analysis comparing surgical and conservative treatment of ankle fractures in adult patients. The primary outcome of interest was ankle-specific function scores. Secondary outcomes of interest included pain, quality of life, the risk of osteoarthritis and the risk of adverse events. The results of this study revealed no significant differences between surgical and conservative treatment in short-term function, pain and short-term health related quality of life, as well as the risk of osteoarthritis, superficial and deep infection, deep vein thrombosis, a shift in treatment, death as a result of treatment, unplanned surgery, and neurovascular injury. While the risk of delayed union or malunion was significantly in favour of the surgery group, the risk of hardware removal was significantly in favour of the conservative group.