Objective To systematically evaluate the effectiveness of augmented reality (AR)-assisted teaching in orthopedic clinical education. Methods PubMed, Embase, Scopus, Web of Science, the Cochrane Library, China National Knowledge Infrastructure, and Wanfang Data were searched by computer from database inception to July 2026 for randomized controlled trials (RCTs) of AR-assisted teaching in orthopedic clinical education. Meta-analysis was performed using RevMan 5.4. The Cochrane Risk of Bias 2 (RoB 2) tool and the GRADE approach were used to assess risk of bias and certainty of evidence, respectively. Results Five RCTs were included, involving 235 learners directly compared between the AR-assisted teaching group and the traditional teaching group. Meta-analysis showed that the AR-assisted teaching group had higher theoretical scores [standardized mean difference (SMD)=3.68, 95% confidence interval (CI) (0.58, 6.78), P=0.02], clinical reasoning ability [SMD=1.75, 95%CI (0.82, 2.68), P=0.000 2], learning interest [SMD=1.87, 95%CI (1.00, 2.75), P<0.000 1], knowledge mastery [SMD=1.64, 95%CI (0.70, 2.58), P=0.000 6], and overall teaching evaluation [SMD=3.05, 95%CI (0.88, 5.22), P=0.006] than the traditional teaching group. Heterogeneity was substantial across outcomes (I2 values ranged from 76% to 98%). Sensitivity analyses showed that the directions of effect for clinical reasoning, learning interest, and knowledge mastery were relatively stable, whereas theoretical scores and overall teaching evaluation were more sensitive to individual studies. GRADE assessment indicated low or very low certainty of evidence for all outcomes. Conclusions Current low- or very-low-certainty evidence suggests that AR-assisted teaching may have beneficial effects on some short-term outcomes in orthopedic clinical education; however, the magnitude and generalizability of these effects remain uncertain. Given the limited number of studies, substantial heterogeneity, and low certainty of evidence, the current evidence is insufficient to support routine implementation of AR in orthopedic clinical education. Further large-scale, multicenter, well-designed RCTs with standardized teaching protocols and assessment criteria, objective skills assessment, and medium- to long-term follow-up are needed.