Forty-one (impending) fractures were reviewed in 39 patients with metastatic bone disease. Thirty-one lesions were located in the femur, and the remaining ten lesions were located in the humerus. In 22 cases there were multiple lesions in the affected bone. All patients were treated with intramedullary nailing, 21 times because of a pathologic fracture and 20 times because of an impending pathologic fracture. There was no mortality related to the surgical procedures. In nine patients the postoperative course was complicated (four technical and five systemic complications). Pain relief was achieved in 29 patients. Ambulatory status was improved in 27 patients. A pathologic refracture in the same bone occurred in five cases, all located in the femoral neck. Intramedullary nailing is useful in the treatment of metastatic bone disease. This technique facilitates stabilization of the whole bone, which in our view, with respect to the presented data, is mandatory.