Herbal decoction with post-surgery for tibiofibular fracture: A systematic review

We evaluated the efficacy and safety of Taohong Siwu decoction (THSWD) as an adjunct to the usual therapy after surgery for tibiofibular fractures.

We conducted a comprehensive literature search across seven databases (MEDLINE [via PubMed], Embase, CENTRAL, CNKI, Wanfang, Sinomed, and CiNii) for relevant articles published from database inception through July 9, 2025. Meta-analyses were performed using a random-effects model. Depending on the outcome types, the results are reported as risk ratios (RRs), odds ratios (ORs), or mean differences (MDs), each with their corresponding 95% confidence intervals (CIs).

We included 24 randomized controlled trials involving 2,048 participants. Compared to treatment as usual (TAU) alone, combined THSWD and TAU was associated with improvements in pain (MD -1.34; 95% CI -1.79 to -0.88, I² = 97%), time to fracture healing (MD -3.68; 95% CI -5.37 to -1.99, I² = 95%), the Hospital for Special Surgery Knee-Rating Scale score (MD 9.00; 95% CI 5.61 to 12.40), and the clinical response (RR = 1.16; 95% CI 1.12 to 1.21). The OR for adverse events was also significantly lower (OR 0.13; 95% CI 0.07 to 0.26) with THSWD combined with TAU. However, the included trials generally had low methodological quality, as assessed by RoB 2.0.

THSWD may serve as an effective adjunctive therapy to TAU to enhance recovery after tibiofibular fracture surgery, although the certainty of the evidence remains low, while potentially reducing adverse events.

www.crd.york.ac.uk/prospero (CRD420251107355).