Objective To explore the effects of Shangke Guyu Decoction on rehabilitation, bone metabolism, and serum inflammatory factors in patients with tibiofibular fracture treated with interlocking intramedullary nail internal fixation. Methods From January 2020 to January 2022, 80 patients with tibiofibular fracture admitted to the Department of Orthopedics of the Putian Fude Hospital University were selected as the study subjects. All patients were divided into an operation group （40 cases） and an auxiliary group of traditional Chinese medicine （TMC） （40 cases） by envelope method. The operation group was treated with interlocking intramedullary nail internal fixation, while the TMC auxiliary group was treated with Shangke Guyu Decoction additionally. The rehabilitation effect, bone metabolism, and serum inflammatory factor levels of the two groups were compared. Results The healing time of tibia and fibula fracture, the time of getting out of bed after operation, and the time of hospitalization in the TCM auxiliary group were significantly shorter than those in the operation group （P<0.05）. The levels of serum alkaline phosphatase, osteocalcin, and C-terminal peptide of type Ⅰ procollagen in the TCM auxiliary group were higher than those in the operation group （P<0.05）. The levels of tumor necrosis factor α, IL-1, and IL-6 in the TCM auxiliary group were lower than those in the operation group （P<0.05）. Conclusion The treatment of tibia and fibula fracture with Shangke Guyu Decoction and interlocking intramedullary nailing can effectively fasten the rehabilitation process of patients, improve bone metabolism, and reduce inflammatory factors.