Objective To explore the nursing value of silk fibroin (SF) dressings for post-fracture incision healing. Methods A retrospective analysis was conducted on 120 patients who underwent surgical treatment for fractures at Kaiyang County People""s Hospital between January 2023 and October 2025. Based on different intervention methods, they were divided into a control group, study group 1, and study group 2, with 40 cases in each group. The control group used vaseline gauze dressings, study group 1 used SF gel dressings, and study group 2 used SF composite gel. All the three groups received routine postoperative anti-infection, pain relief, and functional exercise guidance. They were followed up until 30 d postoperatively. Incision healing time, healing grade, postoperative visual analogue scale (VAS) scores at different postoperative time points, levels of local inflammatory cytokines [interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α)] at the incision site and the occurrence of complications were compared. Results The incision healing times in study group 1 and study group 2 were both significantly shorter than that in the control group (both P＜0.05). The rates of grade A healing were both significantly higher than that in the control group (both P＜0.05). At all postoperative time points, the VAS scores and local IL-6 and TNF-α levels in the two study groups were all significantly lower than those in the control group (all P＜0.05). The total complication rates in the two study groups were both lower than that in the control group (both P＜0.05), and no adverse events such as dressing-related allergies or skin irritation occurred. There were no significant differences in any of the observed indicators between the two study groups (all P＞0.05). Conclusion Both SF gel dressings and SF composite gel can effectively accelerate postoperative incision healing for fractures, reduce postoperative pain, inhibit local inflammatory responses, lower the incidence of complications, and demonstrate good safety. The effects of the two dressings are similar, and clinical selection can be made based on practical circumstances.