Background: Complex Ankle fractures are a serious condition due to their significant morbidity. Open reduction/internal fixation (ORIF) is the standard technique for managing such types of fractures. In spite of the anatomical reduction, the patient may still suffer from some residual symptoms. Recently, arthroscopic-assisted reduction and internal fixation (ARIF) have given promising results as it can identify and manage concomitant intraarticular injuries. Objective: This review article aimed to assess the role of ARIF in treating ankle fractures. Methods: Ankle, Fracture and Arthroscopy were all searched by Science Direct, Google Scholar, and PubMed. The writers also assessed references from pertinent literature, although they only included the most recent or comprehensive study, which ran from January 2006 to February 2023. Documents in languages other than English were not included since there were insufficient sources available for translation. Excluded papers included dissertations, conference abstracts, unpublished publications, oral presentations, and other works not included in longer scientific investigations. Conclusion: ARIF did not show superiority to ORIF in relieving pain and improving the function in those with ankle fractures. However, it provides a reliable tool for diagnosis and treats intra-articular pathology. Finally, the choice between ARIF and ORIF should be dependent upon the specific case and surgeon's evaluation of patients' needs and goals.