Aim: To compare the functional outcomes and the frequency of use of distal tibiofibular stabilization (TFS) in patients with ankle fractures involving the posterior malleolus (PM). Materials and Methods: A systematic literature search was conducted in MEDLINE (PubMed), Scopus and the Cochrane Library databases in accordance with the PICOS and PRISMA guidelines. Studies included in the meta-analysis were analyzed using the Cochrane RevMan software. 20 studies were selected for qualitative analysis and 18 for quantitative analysis, and included 2179 patients. Functional outcomes according to the AOFAS scale in patients with ankle fractures and PM fractures treated with TFS were not statistically different from the control group (MD = 1.00; 95% CI [-4.70, 6.70]; p = .073, I²=87%). A significant decrease in the use of TFS was found in patients after fixation of the PM (OR = 3.77; 95% CI [2.13, 6.69]; p < 0.00001, I²=78%) and in patients who had PM fixation with a buttress plate (OR = 0.44; 95% CI [0.25, 0.79]; p = 0.006, I²=0%). Conclusions: The use of additional TFS after fixation of the PM does not affect the functional outcomes of treatment of patients with ankle fractures. Fixation of the PM fragment significantly reduces the need for TFS. Open repositioning and osteosynthesis of the PM by a buttress plate reduces the need for TFS as compared to screws.