Fractures can lead to pain, limited mobility, and a decreased quality of life. Treatment typically involves surgical or conservative approaches, often accompanied by complications. Stem cell-derived exosomes (EXOs), characterized by excellent biocompatibility, low immunogenicity, intrinsic stability, and targeting ability, have emerged as a current research hotspot. Exosomes hold certain advantages in promoting fracture healing; they can regulate the functions of osteoblasts and osteoclasts, angiogenesis, and cartilage regeneration, which may improve clinical treatment outcomes and reduce the incidence of fracture complications. In this article, we review the research progress on exosomes derived from human umbilical cord mesenchymal stem cells (HUC-MSCs) in promoting fracture healing, exploring the critical role of HUC-MSC-derived exosomes in this process.