The study analyzed 309 elderly patients with trochanteric fractures admitted in 2021–2023, divided into three groups according to treatment: group A (home recovery, n=81), group B (inpatient conservative treatment, n=97) and group C (hospital surgical treatment, n=131). Patients in group C were younger, had fewer comorbidities, and better baseline function, while patients in group A were older, frailer, and more functionally dependent; the characteristics of group B were intermediate. Complications differed: group C had mainly surgical complications, group B had problems with fracture healing and immobilization, group A had the most impaired fracture healing. One-year survival was 95.42% in group C, 91.75% in group B, and 83.95% in group A, reflecting the frailty gradient. Functional recovery showed a parallel distribution by group. The study provides a reference for individualized treatment decision-making in this heterogeneous population.