Purpose <p>The optimal temporising strategy for ankle fracture-dislocations is a highly debated topic. These unstable injuries are commonly managed with staged fixation to allow for soft tissue recovery, using either plaster splinting or ankle-spanning external fixation. This study aimed to compare the efficacy and safety of these two approaches.</p> Methods <p>A systematic search of MEDLINE, Embase, Scopus, Cochrane CENTRAL, and Google Scholar was conducted. Comparative studies evaluating temporary external fixation versus plaster splinting in skeletally mature patients with ankle fracture-dislocations were included. Meta-analyses were performed to assess differences in loss of reduction prior to definitive fixation, soft tissue complications, and time to definitive fixation. Risk of bias was assessed using ROBINS-I tool, and certainty of evidence was appraised using GRADE.</p> Results <p>Nine retrospective cohort studies comprising 1638 patients were included (589 external fixation, 1049 splinting). Loss of reduction occurred in 3% of injuries in the external fixation cohort compared with 14.6% in those managed with plaster splinting (RR 0.22; 95% CI 0.09–0.52). Rates of overall soft-tissue complications were similar between cohorts. The data regarding time to definitive fixation were highly heterogeneous across studies. Overall certainty of evidence was moderate for LOR and very low for Soft Tissue Complications and Time to ORIF.</p> Conclusion <p>Temporary external fixation significantly reduces loss of reduction compared with plaster splinting in AFDs, without an increase in soft-tissue complications. External fixation may be advantageous in higher-risk fracture patterns or when delayed definitive fixation is anticipated. Further prospective studies are required to refine patient selection and optimise temporising protocols.</p>