Hip fractures are the type of osteoporotic fracture that most affects the elderly. Unlike fractures of the wrist or shoulder, hip fractures cause pain and impaired movement of the lower extremities, forcing the patient to be bedridden, making it difficult to move around; conservative treatment requires bed rest for about three months, and bed rest brings four major complications: respiratory infections, urinary tract infections, deep vein thrombosis and bed sores, all of which can endanger the patient’s life if any of them occurs. Therefore, once a hip fracture occurs, even conservative treatment can be dangerous, and surgery is risky, so hip fracture was called “the last fracture of life” in the past, meaning a fracture whose life is in danger if it occurs. Therefore, compared with the risk of surgery, the risk of conservative treatment requiring bed rest in March is not less, or even greater. In this case, the principle of hip fracture treatment can be summarized as “surgical treatment if possible”. This is not the same as “conservative treatment whenever possible” for most fractures. It is important to understand this because most of the patients with hip fractures are elderly and have comorbidities such as hypertension and diabetes, and many of them have a history of surgery and often have greater doubts about surgical treatment. Surgery is like breaking through a barrier, requiring the cooperation of orthopedic surgeons, anesthesiologists, intensive care units, internal medicine and other departments, as well as the patient and family. But in comparison, conservative treatment is a much longer and bigger hurdle, and the passing rate is not even as high as that of surgery. Therefore, it is necessary for both doctors and patients to fully communicate and make up their mind in order to get through the perioperative period; and once the surgery is successful, the patient will have a much better chance of recovery and the best treatment results. Depending on the location of the fracture, hip fractures are divided into femoral neck fractures and intertrochanteric fractures, and their surgical treatment methods are different. Femoral neck fracture is an intra-articular capsule fracture, especially the subcapital type fracture, which is easy to injure the blood flow after the injury, and fracture non-union or femoral head necrosis occurs; while intertrochanteric fracture is an extra-capsule fracture, and the incidence of fracture non-union or femoral head necrosis is lower, but the rate of deformity healing is high. For this difference, the treatment of femoral neck fractures focuses on whether the femoral head can be preserved: if there is little dislocation or if there is already an impingement, especially in younger patients, the femoral head can be preserved and the fracture fixed with three hollow screws; however, if a more pronounced dislocation has occurred, artificial joint replacement surgery is the best option. Both screw fixation and joint replacement have long been mature, and the operation usually takes less than an hour and does not bleed much. In the case of intertrochanteric fractures, joint replacement is rarely performed and treatment focuses on stable fixation of the fracture. Currently, the main method is internal fixation with an intramedullary nail in the femur, which is also a minimally invasive method, without direct incision of the fracture site, with little trauma and generally within an hour or so. Even for elderly people with multiple medical diseases, hip fracture surgery is mostly tolerable; the biggest advantage after surgery is that they can get down to the ground soon, thus avoiding many bed-ridden complications, which greatly improves the treatment effect compared with conservative treatment. The grandmother mentioned above received surgery on the advice of her doctor and was able to walk on the ground 3 days after the surgery and recovered her quality of life very quickly. The average age of hip fracture is over 70 years old, which is the oldest fracture in the human body; therefore, the current treatment methods are targeted at the elderly accordingly, emphasizing the reduction of bed rest and early activity. The decision to operate must be made on a case-by-case basis, but the general principle is that surgery is often more effective than conservative surgery, and there is no need to be afraid of surgery.