Objective To investigate the risk assessment ,prevention and management for perioperative stroke in elderly patients with hip fractures. Methods A total of 179 patients aged 65 years and older were admitted to our department due to hip fracture. In managements of perioperative stroke ,the preoperative risk assessment and the management of stroke ,identifying the risk population for stroke prevention ,controlling risk factors of the preoperative stroke ,intraoperative monitoring , postoperative treatment ,etc.were studied retrospectively.The incidence of perioperative stroke was recorded and analyzed. Results Of 179 patients with hip fracture ,overviews of diagnosis and treatment were as follows.Twenty-four (24/179 ,13.41% ) cases did not receive operative treatments.Head and neck CT angiography(CTA)-showed severe stenosis or occlusion of intracranial artery and internal carotid artery were in 9(5.03% ,9/179)patients ,of whom the 5(2.79% ,5/179) cases underwent cerebrovascular digital subtraction angiography (DSA ) ,balloon dilation and stent implantation ,then received the operation for hip fracture 10 days later ,finally were discharged uneventfully.1 (0.56% ,1/179 ) patient underwent orthopaedic surgery due to the results of DSA showing no indication of interventional therapy ,and was discharged unevenfully.3 (1.68% ,3/179 ) patients refused to receive the further DSA examination or interventional therapy ,strongly demanded for orthopaedic surgery and would take the surgical risk ,and were discharged uneventfully.2(1.12% , 2/179)patients were found to have cerebral aneurysm diagnosed by CTA and DSA ,and underwent surgery for hipfracture without special treatment.2(1.12% ,2/179)patients were diagnosed as new occurrence of cerebral infarction before the operation ,and received head and carotid stenting at the department of cerebrovascular surgery ,followed by combined antithrombotic therapy of aspirin , clopidogrel and low molecular weight heparin for 4 weeks ,then underwent orthopaedic surgery for hip fracture.2 (1.12% ,2/179 ) patients were diagnosed as new cerebral infarction after orthopaedic surgery ,then were transferred to the department of neurology for treatment. Conclusions The thorough preoperative risk assessment and management of stroke ,reasonable perioperative antiplatelet and anticoagulation therapy ,intense intraoperative monitoring and active postoperative complications management make it possible for high-risk and new ischemic stroke patients with hip fractures to receive early orthopaedic treatment.