Eleven randomized controlled trials including 930 patients with surgically treated ankle fractures were included in this systematic review and meta-analysis comparing early vs. delayed weight bearing and/or mobilization. Pooled outcomes of interest included the Olerud Molander Ankle Score (OMAS) at 1 year and 12 weeks, return to work, quality of life, and complication rates. At 12 weeks, early weight bearing significantly improved ankle function scores compared to delayed weight bearing, but no differences were observed at 1 year. Early mobilization showed no significant functional benefit and was associated with higher complication rates. The main finding suggests early weight bearing improves short-term functional recovery without increasing complications, while early mobilization may increase wound complications without added functional benefit.