Background <p>Psychological safety is a critical aspect of clinical nursing care. This study aimed to evaluate the psychological safety and its influencing factors among elderly patients following traumatic fracture surgery, to inform targeted psychological interventions in clinical practice.</p> Methods <p>Elderly patients who underwent surgery for traumatic fractures at our hospital between March 2024 and March 2025 were included for survey. A validated and previously reported psychological safety scale was used to assess the psychological safety. Multiple linear regression analysis was conducted to identify the potential influencing factors. Clinical trial number: not applicable.</p> Results <p>A total of 246 elderly patients with traumatic fractures were included in this study. The mean psychological safety score was 38.60 ± 7.15. Correlation analysis revealed significant associations between psychological safety and several variables, including age (<i>r</i> = -0.616), marital status (ρ = 0.528), educational level (ρ = -0.610), place of residence (ρ = 0.541), average monthly household income (<i>r</i> = -0.623), and whether the fracture was open (ρ= -0.652) (<i>p</i> &lt; 0.05). Furthermore, multiple linear regression analysis confirmed that age, marital status, educational level, place of residence, average monthly household income, and whether the fracture was open were associated with psychological safety among elderly patients following traumatic fracture surgery (<i>p</i> &lt; 0.05). Specifically, patients with open fractures scored significantly lower on psychological safety (B = -2.858, <i>p</i> = 0.017) compared with those with closed fractures.</p> Conclusion <p>The psychological sense of security among elderly patients following traumatic fracture surgery remains suboptimal and warrants improvement. Healthcare professionals should implement targeted interventions based on the identified influencing factors to provide effective support and enhance the psychological safety of these patients.</p>