Twenty randomized controlled trials, including 1328 patients with unstable ankle fractures treated with ORIF, were analyzed in this meta-analysis. The study compared early mobilization (EM) versus immobilization (IM) in 724 patients and early weightbearing (EWB) versus non-weightbearing (NWB) in 1088 patients. Pooled outcomes of interest included clinical function (Olerud Molander Ankle Score, OMAS), time to return to work, and postoperative complications. Results showed that early mobilization did not significantly improve short- or long-term clinical outcomes but was associated with a significantly faster return to work. Early weightbearing did not show significant benefits at short term but improved long-term clinical outcomes. No significant differences in complication rates were observed between groups. These findings suggest that both EM and EWB are safe strategies, with benefits in recovery time and functional outcomes.