A retrospective review of 56 hip fractures in 52 patients aged 90 years and older was performed, looking specifically at perioperative morbidity and mortality, one-year mortality, and postoperative functional outcome. The one-year mortality rate was 46% as compared to 22% in younger individuals. The presence of cerebral dysfunction preoperatively proved to be the major risk factor for increased mortality. The highest one-year mortality rate was seen in those patients with cerebral dysfunction who were ambulators preoperatively, and the lowest mortality rate was in nonambulators. Only 25% of functional ambulators preoperatively gained a similar level of function postoperatively. Despite these findings, the low perioperative mortality and morbidity indicate that operative treatment is still the treatment of choice in all nonagenarians with hip fractures, as it provides for easier nursing care and maximized functional outcome, with an expected 54% one-year survival rate.