Proximal femur fractures (PFF) are extremely common in the field of orthopaedics. PFF occurs in older patients and is often associated with other coexisting conditions and osteoporosis. About 13% of the world’s population is older than 65 years of age, and 1.6 million hip fractures secondary to osteoporosis occur each year. There are still many factors other than osteoporosis that influence the incidence of PFF, for example, in countries such as Europe, where higher body mass index (BMI) also leads to a higher incidence of hip fractures. In the past 40 years, despite aggressive treatment measures, prevention programs, and guidelines, PFF mortality has not been significantly reduced. Consequently, controversies and studies on the treatment of PFF have also been of great interest. Optimization of preoperative and postoperative management according to NICE guidelines is expected to result in a 10% reduction in 30-day mortality and a 30% reduction in 3-month mortality. It is extremely necessary to rigorously screen the level of patients with PFF to identify which patients are at risk of adverse outcomes postoperatively. Hu et al. found by Meta-analysis that advanced age, male, family/private residential care, poor preoperative ambulation, poor activities of daily living, higher ASA classification, poor mental status, multiple co-morbidities, dementia or cognitive impairment, diabetes, cancer, and cardiac disease were associated with hip fracture mortality . Patients’ simple intelligence test scores, mobility, and living environment were associated with mortality at 5 years postoperatively. These simple predictors are often obtained during communication with the patient. However, there is a lack of strong prospective evidence on whether these methods improve patient survival. Two hospitals in England have introduced the Japanese car manufacturer Toyota’s “Lean In” theory of efficiency to improve the prognosis of hip fractures by bringing patients back to pre-injury levels physically and psychologically in a variety of ways, reducing mortality to 5-10%. At the same time, biological indicators also influence postoperative mortality in PFF, and Laulund et al. showed by Meta-analysis that low hemoglobin, low total lymphocyte count (TLC), low albumin count, low albumin/high total lymphocyte count, low albumin/low total lymphocyte count, high creatinine, and high parathyroid hormone are associated with high mortality in PFF. Other studies have shown that high direct lymphocyte count and total serum calcium are also independent predictors of postoperative mortality in PFF. In elderly PFF patients, cytokine levels (TNF-a, IL-6a, IL-10) are also associated with postoperative complications and mortality. If the hemoglobin is below 12 after injury, after rehydration therapy, the hematocrit level should be measured again to avoid delaying surgery due to the need for blood transfusion. Hemiprosthetic and total hip replacements (in younger patients) are commonly used to treat intracapsular femoral neck fractures. Internal fixation may also be used for certain types of fractures. Undisplaced femoral neck fractures can be fixed with three hollow compression screws, and recent studies have shown that these fractures can also be treated with two expandable hollow screws. A Meta-analysis of intertrochanteric fractures concluded that the sliding hip screw system is the best fixation method for stable intertrochanteric fractures. For anteversion fractures, intramedullary nail fixation is preferred because of the extreme instability of the fracture. In one study, cement augmentation techniques were effective in enhancing the mechanical stability of the fracture site for early weight-bearing activities. Several studies have presented the clinical and mechanical results of a new proximal femoral intramedullary nail (Targon PF) for the treatment of proximal femoral fractures. In a randomized controlled trial comparing the efficacy of the Targon PF intramedullary nail with that of the sliding hip screw, Parker et al. showed that the intramedullary nail group regained mobility earlier. In a randomized controlled study of hemiarthroplasty, there was no significant difference between cemented Thompson prostheses and Exeter trauma prostheses, and these constructs were used primarily in elderly patients with low motion and without the need for repeat arthroplasty. Perioperative anticoagulation remains a clinical challenge, and NICE believes that coagulation should be regulated to prevent delayed surgery, but there is no clear guidance on how and when to do this effectively. Haider, on the other hand, recommended that surgery should be postponed for 2-3 days when patients are taking the antiplatelet drug clopidogrel. One report suggested that 1 mg of vitamin K could be given to reverse the patient’s blood clotting status if the patient was taking warfarin preoperatively. A retrospective study concluded that the use of vitamin K to antagonize the anticoagulant effect of warfarin could shorten the time from injury to undergoing surgery by 2 days. However, this approach still needs to be supported by prospective studies with large samples. There are still many challenges to overcome to improve the prognosis of patients with PFF. As the incidence of PFF increases, so does its impact on the resources of the National Health Service. Recent improvements such as rapid clinical pathways, early surgical interventions, improved rehabilitative training methods and built-in designs have reduced length of stay, complication rates and mortality. Ongoing research projects may clarify which laboratory indicators require additional measures to improve patient prognosis. And (government) should support large randomized controlled trials with different inserts, different laboratory parameters, and different anticoagulation modalities to continue to improve PFF outcomes.