Objective:This case report summarizes perioperative multidimensional nursing for an elderly patient with thoracic vertebral fracture combined with lacunar infarction, to provide a reference for clinical nursing of elderly complex orthopedic patients. Methods:A 73-year-old male with T12 compression fracture and lacunar infarction received full-cycle quantitative risk assessments (Braden, Wells, SAS, Morse scales) and a tailored multidisciplinary nursing program covering precise preoperative prevention, intraoperative safety control, postoperative multimodal intervention, and discharge extended care. Integrated Western medicine, traditional Chinese medicine (TCM) therapy, and staged rehabilitation were implemented. Results:The patient was hospitalized for 3 days without pressure injury, DVT, pulmonary infection, or other complications. NRS pain score decreased from 4 to 2. At 1-month follow-up, lower extremity muscle strength remained grade 5, and thoracic mobility recovered to 80% of pre-fracture level. At 3 months, SF-36 score rose from 55 to 86, with clinical fracture healing and stable bone cement filling. Conclusion:Standardized risk assessment plus integrated Chinese-Western nursing, staged rehabilitation, and extended care can effectively reduce complications, relieve pain, and improve functional recovery and quality of life in elderly high-risk patients.