Background: Previous studies comparing surgical fixation methods in patients with tibial pilon fractures have controversial results. This study aims to identify which surgical method provides the best clinical and functional outcomes in adult patients with closed tibial pilon fractures. Methods: Databases including grey literature were searched for studies comparing surgical treatment methods in adult patients with closed tibial pilon fractures. PICO criteria were used to select studies. Statistical analysis was conducted with RevMan Version 5.4. The effect of compared methods was estimated using the mean difference, relative risk and corresponding 95% confidence intervals. Results: Three RCTs and one cohort study met our inclusion criteria and were included in the metaanalysis. All studies compared External fixation combined with limited internal fixation (LIFEF) with Open reduction internal fixation (ORIF) and had an overall high risk of bias. There was no difference in superficial infection rates (p=0.55), but there was a marginal difference in osteomyelitis rates (p=0.07) and wound dehiscence (p=0.05), favoring LIFEF. Malunion and arthritis rates (p=0.53 and p=0.27 respectively) were similar. Finally, none of the two treatment methods offered a better functional score (p=0.53). Conclusion:Both LIFEF and ORIF can be used in patients with closed tibial pilon fractures, when the condition of soft tissues allows. Overall, they offer similar early and long-term outcomes, however, patients treated with ORIF are in higher risk of developing osteomyelitis and wound dehiscence, as shown in this meta-analysis. More high-quality studies comparing treatment methods for tibial pilon fractures are needed, as treatment remains controversial.