Objective To systematically evaluate the clinical efficacy of kidney-tonifying and blood-activating traditional Chinese medicines as adjunctive therapies for distal radius fractures using a Meta-analysis, and to preliminarily explore their mechanisms of action through network pharmacology. Methods PubMed, Web of Science, Cochrane Library, Embase, CBM, CNKI, Wanfang, and VIP databases were searched from inception to June 2026 to identify clinical controlled studies comparing traditional Chinese medicine decoctions combined with conventional Western medicine versus conventional Western medicine alone for distal radius fractures. RevMan 5.4 software was used for Meta-analysis, and network pharmacology was employed to screen core active components, predict targets, and conduct pathway enrichment analysis. Results A total of 23 studies involving 3 377 patients were included. The Meta-analysis results showed that both kidney-tonifying and blood-activating traditional Chinese medicines significantly improved the clinical effective rate, shortened fracture healing time, reduced visual analog scale (VAS) pain scores, increased osteocalcin levels, and improved wrist joint function, with no statistically significant difference in overall efficacy between the two categories (all P > 0.05). Blood-activating traditional Chinese medicines showed superior improvements in wrist dorsiflexion range of motion, while kidney-tonifying traditional Chinese medicines exhibited more stable efficacy with lower heterogeneity. Network pharmacology identified core targets such as tumor protein p53 (TP53), proto-oncogene tyrosine-protein kinase Src (SRC), signal transducer and activator of transcription 3 (STAT3), primarily regulating pathways including phosphatidylinositol-3-hydroxykinase (PI3K)-protein kinase B (Akt), mitogen-activated protein kinase (MAPK), nuclear factor-κB (NF-κB). Blood-activating traditional Chinese medicines exerted anti-inflammatory and microcirculation-improving effects mainly through vascular endothelial growth factor (VEGF), tumor necrosis factor (TNF), and Janus kinase (JAK)-STAT pathways, whereas kidney-tonifying traditional Chinese medicines promoted osteogenic differentiation and bone metabolism via the Wnt/β-catenin pathway and cell cycle pathways. Conclusion Kidney-tonifying and blood-activating traditional Chinese medicines are effective and safe as adjunctive therapies for distal radius fractures, both promoting fracture healing through multi-component, multi-target, and multi-pathway mechanisms. Blood-activating traditional Chinese medicines are more suitable for relieving swelling and pain in the early stage, while kidney-tonifying traditional Chinese medicines are better for strengthening bone and promoting healing in the middle and late stages.

distal radius fracture  /  blood-activating traditional Chinese medicine  /  kidney-tonifying traditional Chinese medicine  /  Meta-analysis  /  network pharmacology  /  bone metabolism