Two patients with ultra-senior hip fractures were recently discharged from the hospital after surgical treatment by the author: one was 99 years old and the other was 98 years old. Why take a big risk to operate on such elderly patients? It starts with the characteristics of elderly hip fractures. Elderly hip fractures generally refer to intertrochanteric fractures and femoral neck fractures (commonly known as “hip shaft fractures” in Beijing), and they are more common in elderly women, especially intertrochanteric fractures that occur at a higher age. It is mainly related to osteoporosis and poor muscle strength. The main manifestations are hip pain, immobility, and external rotation of the affected limb after a fall. With the aging of the population, the incidence tends to increase. Surgery is the preferred treatment for hip fractures in the elderly. Although there are certain risks associated with surgical treatment, statistics from a large amount of clinical data show that non-surgical treatment has a higher morbidity and mortality rate. Because conservative treatment generally requires more than 6-8 weeks of bed rest, the resulting serious complications such as pulmonary infection, urinary tract infection, decubitus ulcers, deep vein thrombosis, and thromboembolism of vital organs such as lung, brain, and heart have a high mortality rate for elderly patients. In addition, potential complications such as malunion or non-union of fractures and femoral head necrosis also seriously affect the quality of life of patients. The aim of surgical treatment is to shorten the time of bed rest, restore the movement of the affected limb as soon as possible, and reduce mortality and other complications. For intertrochanteric fractures, a minimally invasive approach is generally used with internal fixation using various proximal femoral intramedullary nails; while for elderly femoral neck fractures, arthrodesis is a better option.