〔Abstract〕 Objective To observe the effects of self-designed Jiangu Qiangjin Decoction fumigation on bone metabolism and joint function in elderly patients with ankle fracture. Methods The data of elderly patients with ankle fracture treated in Kaifeng Central Hospital from January 2021 to January 2022 were retrospectively analyzed. 49 patients receiving conventional postoperative treatment were included in the control group, and 49 patients receiving fumigation treatment with self-designed Jiangu Qiangjin Decoction on the basis of conventional postoperative treatment were included in the observation group.The rehabilitation progress of the two groups was compared, and the changes of joint function, range of motion, muscle strength and serum bone metabolism indexes were observed before and after treatment. Results The time to normalizing joint movement function, walking time to return to life and full weight-bearing time in the observation group were shorter than those in the control group, and the differences were statistically significant (P < 0.05). After treatment, the scores of Olderud-Molander, American Association of Foot and Ankle Surgery (AOFAS), Tinetti and Baird-Jackson in the two groups were higher than those before treatment, and after treatment, the scores of Olderud-Molander, AOFAS, Tinetti and Baird-Jackson in the observation group were higher than those in the control group. The differences were statistically significant (P < 0.05). After treatment, the muscle strength and joint motion of the two groups were increased compared with those before treatment, and after treatment, the muscle strength and joint motion of the observation group were greater than those of the control group, the differences were statistically significant (P < 0.05). After treatment, the levels of bone gla–protein (BGP) and precollagen carboxy–terminal peptide (PICP) in the two groups were increased compared with those before treatment, the levels of total bone procollagen type I amino terminal extender peptide (Total-PINP) and the C–terminal peptide of type I collagen β Special sequence (β-ctx) were lower than those before treatment, and the levels of BGP and PICP in the observation group were higher than those in the control group after treatment. The levels of Total-PINP and β-ctx were lower than those in the control group, and the differences were statistically significant (P < 0.05). Conclusion Self-designed Jiangu Qiangjin Decoction fumigation treatment can promote fracture rehabilitation in elderly patients with ankle fracture, enhance bone metabolism, and better improve the function of the affected joint.