With the development of society, people’s living standard is improving, especially the continuous improvement of health care, so that China has entered an aging society. However, as all elderly patients have different degrees of osteoporosis, especially the hip is a good site for osteoporosis, and a minor trauma or fall can lead to hip fracture (including femoral neck fracture, intertrochanteric fracture, etc.). Therefore, hip fracture is a common part of fracture in elderly people, who often have coexisting diseases of other systems. Choosing the right treatment method is the key to improve the quality of life and recovery. Treatment method: Hip fracture is a common fracture in the elderly, but the physiological function of elderly patients declines, often combined with heart, brain, lung, metabolic and other system diseases, after the injury, if long-term bed rest not only inconvenient care, and prone to bed sores, pneumonia, cardiovascular disease, urinary tract infection and many other complications, so that the original cardiovascular disease and liver and kidney function damage further aggravated, serious multi-organ function failure and high mortality. Therefore, surgery is preferred because it can significantly shorten bed rest, reduce complications and improve survival rate. Indications for surgery: A proper preoperative assessment of whether the patient can tolerate surgery is required, and the pros and cons of various treatments are actively and carefully balanced. It is generally believed that surgery is better tolerated by patients who are capable of taking care of themselves before the injury, who can usually walk outdoors, and who can perform light physical labor; surgery is not recommended for cases with severe arrhythmias (especially ventricular arrhythmias), acute heart attack, history of angina pectoris within 3 months, and cases with significant cardiopulmonary failure; for cases with combined pulmonary infection, anemia, diabetes, and electrolyte imbalance. In cases of combined pulmonary infection, anemia, diabetes mellitus and electrolyte imbalance, surgical treatment should be actively performed after active medical treatment. Perioperative preparation: A comprehensive assessment of the patient’s general condition, detailed medical history, comprehensive physical examination, detection of liver, kidney, heart and lung function, coagulation mechanism and electrolytes, and active treatment of relevant comorbidities should be made before surgery to create conditions for surgery. For patients with anemia, the hemoglobin level should be actively increased by various means before surgery to improve the ability to tolerate surgery. For patients with combined hypertension, the blood pressure should be lowered to normal or high normal level before surgery. For patients with combined diabetes mellitus, the blood glucose should be controlled to a safe level of less than 10 mmol/L. If the blood glucose is controlled to less than 8.0 mmol/L in the hospital, no special treatment is needed. For those with combined arrhythmias, atrial arrhythmias can generally be left untreated, while ventricular arrhythmias require antiarrhythmic and myocardial nutrition therapy. For those who have pulmonary infection, anti-infection treatment should be routinely administered. The electrolyte imbalance should be corrected before surgery. Selection of surgical plan: For the treatment of senior hip fracture, some scholars advocate active surgical treatment as long as the patient’s life expectancy is more than 6 months and there is no extensive organ failure, in order to increase the survival rate and improve the quality of life of the patient. The surgery should be as simple, effective, short, traumatic and less bleeding as possible. Femoral neck fracture: Elderly patients often have high rates of femoral head necrosis and bone non-union due to osteoporosis, and artificial joint replacement is the best choice. Although artificial femoral head replacement is less traumatic than total hip replacement, it is prone to joint wear, joint particles and postoperative hip pain in the long term, so total hip replacement is generally performed. Therefore, we only use artificial femoral head replacement for cases that are older than 75 years old and the economic conditions do not allow total hip replacement. DHS (sliding hip) and PFN internal fixation can provide strong bending and shearing forces, effectively prevent hip inversion and ensure smooth healing of the fracture. The physiological characteristics of elderly patients are different from those of young adults, and the risk of anesthesia is relatively high, but the smoothness and success of anesthesia largely depends on the anesthesia method and the dose of anesthetics. Continuous epidural anesthesia has less interference with the general condition, especially the stability of the circulation, and is effective for lower limb surgery, and the patient is awake during the operation, which is conducive to the recovery of postoperative functions. In this group of cases, continuous epidural anesthesia or continuous epidural anesthesia plus lumbar anesthesia was chosen. For those who use lumbar anesthesia, the level of anesthesia must be controlled below chest 8, and chest 10 is better, so as to ensure intraoperative painlessness, but also conducive to intraoperative circulatory stability, to ensure surgical safety. Postoperative management: correct and effective postoperative management is the key to successful surgery. The changes of vital signs should be closely monitored in the early stage, and the patient should be alerted to possible complications such as pulmonary infection, circulatory decompensation, electrolyte imbalance, lower limb deep vein thrombosis and fat embolism. The patient should be instructed to perform muscle contraction training on the affected limb in bed to reduce muscle atrophy and prevent the formation of deep vein embolism. In addition, for femoral neck fractures with internal fixation, avoid cross-leggedness, lateral lying and premature grounding. Patients with artificial femoral head replacement or artificial total hip replacement can go down early, but avoid dangerous movements such as hip flexion, knee flexion, lower limb inversion and internal rotation. Patients with internal fixation of rudimentary fractures must avoid premature weight-bearing to avoid hip inversion. In elderly hip fractures, age is not a contraindication to surgery, and we advocate active surgical treatment for those whose systemic condition allows it. Preoperative evaluation of the patient’s systemic organs and systems, strengthening of perioperative management, rational selection of surgical plan, familiarity with the indications and operating techniques of various instruments, and standardized postoperative management are all necessary to achieve satisfactory results in hip fracture surgery in the elderly.