4 studies (2 randomized control trials [RCTs] and 2 case series) comparing intramedullary nail and extramedullary plate fixation for treatment of lateral malleolus fracture were included in this systematic review and meta-analysis. The purpose of the study was to analyze all available data comparing the fixation methods to determine if one method provided better outcomes. Intramedullary nailing was found to be associated with a significantly smaller incision size and shorter operative time in 1 of the included studies, as well as significantly lower pooled incidences of wound infection, symptomatic hardware, and hardware removal. Results were mixed regarding functional outcome; 1 study reported a significant benefit of intramedullary nails versus extramedullary plates, while another study reported no significant differences between groups. No significant difference between groups was observed in the quality of reduction, or incidences of deep infection, delayed union, malunion, nonunion, and construct failure.