With the aging of the social population, it is very important to perform proper perioperative management because the elderly are prone to hip fractures after falls due to osteoporosis and high perioperative mortality. Due to the declining function of the elderly, the compensatory capacity of each organ decreases, and most patients have damage to heart, lung, liver, kidney, brain and other organ functions, the incidence of these coexisting diseases has been reported to be 73.5%, and the mortality rate of femoral neck and intertrochanteric fracture is as high as 35%. The perioperative intervention and treatment are particularly important in order to meet the functional needs of the patient. (1) Cardiovascular disease: Preoperative cardiac function tests should be performed to fully consider whether the patient’s cardiac function can tolerate surgery and anesthesia, as well as possible problems, and to make appropriate preparations before surgery. In addition to oral antihypertensive drugs for hypertensive patients, controlled hypotension can be chosen during intraoperative anesthesia to stabilize the patient’s blood pressure. (2) Diabetes control: preoperative insulin control of blood glucose, intraoperative and postoperative patient fasting period using intravenous high nutrition and insulin treatment, so that the patient’s blood glucose stable to prevent the occurrence of ketoacidosis. (3) Respiratory system diseases: the perioperative period is the peak period for pulmonary infections, therefore, for patients with respiratory system diseases, while controlling inflammation with drugs, “breathing training” should be carried out to encourage patients to breathe deeply, cough hard, regularly assist in turning and patting the back, and routine nebulized inhalation. (4) Choice of anesthesia: Successful anesthesia is a prerequisite for successful surgery, therefore, preoperative anesthesia with less disturbance to the body’s circulation and metabolism should be reasonably chosen according to the condition to prevent various anesthetic complications, for example, sciatic nerve conduction block anesthesia can be used for inferior femoral fracture to minimize the risk of anesthesia. (5) Prevention of deep vein thrombosis and pulmonary artery embolism: using the principle of gravity, elevate the affected limb to promote venous return, and instruct the patient to perform toe and ankle dorsiflexion exercises and give passive muscle massage after anesthesia disappears. (6) Treatment of osteoporosis: in the elderly population with osteoporotic fractures, only the diagnosis of fracture is often made in the diagnosis, neglecting osteoporosis as the cause, so treatment of osteoporosis by oral or intravenous administration of drugs, supplemented by necessary functional exercises, is essential to prevent the reoccurrence of fractures. In summary, the treatment of hip fractures in elderly patients is no longer simply a matter of treating the fracture, which places higher demands on the contemporary orthopedic surgeon.