Geriatric fractures represent a major public health burden in aging societies, with perioperative outcomes being influenced by a multitude of interconnected factors. This review systematically summarizes the latest research advances in the risk factors and clinical management strategies for perioperative prognosis in elderly fracture patients. Epidemiological evidence indicates a marked age-related increase in fracture incidence, with significant prognostic heterogeneity across different fracture subtypes. Pathogenetically, age-associated impaired fracture healing capacity, osteoporosis, and perioperative complications (including delirium, deep vein thrombosis, and surgical site infection) constitute the core determinants of poor perioperative outcomes. In terms of clinical management, the implementation of Enhanced Recovery After Surgery (ERAS) protocols, multidisciplinary team (MDT) collaboration, personalized pharmacotherapy, and optimized perioperative rehabilitation has been proven to improve prognosis. In this review, we further supplement and refine four evidence-based preventive strategies: preoperative precise risk stratification, perioperative nutritional support, fall prevention combined with home safety intervention, and digital remote monitoring with hierarchical follow-up, which further improve the comprehensiveness and clinical applicability of the perioperative management system for elderly fracture patients. Looking forward, the application of novel biomaterials and artificial intelligence-based personalized precision medicine is expected to provide new directions for the prevention and treatment of geriatric fractures and further optimize perioperative prognosis.