BACKGROUND: Ankle fractures are common injuries that can lead to long-term complications, including post-traumatic osteoarthritis. The rate of surgical intervention for osteoarthritis following fracture fixation is unclear. Understanding the burden of subsequent procedures is essential to inform patients and guide treatment strategies. This review investigates the risk of surgical interventions for osteoarthritis after surgical fixation of ankle fractures. METHODS: We performed a systematic review following PRISMA 2020 and registered the protocol in PROSPERO (CRD42024615284). We included studies of adults (≥ 16 years) with acute ankle fractures treated surgically who later required operative treatment for osteoarthritis. Two reviewers independently performed data extraction and risk-of-bias assessment (Newcastle-Ottawa Scale). Because of clinical and methodological heterogeneity, we synthesised findings narratively. RESULTS: From 2,425 records screened, eight cohort studies (n = 133,367) met inclusion criteria. The reported risk of ankle fusion or replacement due to osteoarthritis ranged from 0 to 4.2%, with mean follow-up ranging from 17 months to 21 years. One large registry study contributed the majority of patients. CONCLUSIONS: Reported rates of re-intervention for post-traumatic ankle osteoarthritis are low in the short to medium term but interpretation is limited by heterogeneity, generally short follow-up, and reliance on a single large registry cohort. High-quality, long-term studies are needed to determine the true lifetime burden and modifiable risk factors.