Objective: This study aims to evaluate the effectiveness of ORIF versus EF in treating Pilon fractures in athletes. Methods: A comprehensive literature search spanning January 2007 to December 2018 was conducted across databases including EMBASE, PubMed, and the Cochrane Library. The QUADAS score assessed the quality of the included studies. Data extraction was performed using Revman software. Results: Out of 413 initial papers, 10 met the inclusion criteria. The studies compared the incidence of superficial and in-depth infections, arthritis, malunion, and nonunion between ORIF and EF groups, as well as the time to bone healing. The ORIF group showed a significantly lower occurrence of superficial infections (OR= 0.33, P<0.05), malunion (OR= 0.33, P<0.05), and nonunion (OR= 0.45, P<0.05), with no significant differences in in-depth infections, arthritis, and bone healing time. Conclusion: ORIF is more effective than EF in reducing the risk of superficial infections, malunion, and nonunion in athletes with Pilon fractures, with comparable outcomes in in-depth infections, arthritis, and bone healing time.