The results in a series of 42 patients with 48 impending or complete pathological femur fractures stabilised with the Long Gamma nail (Howmedica-Osteonics, Rutherford, NJ,USA) are presented. Twenty two impending and 26 completed pathological femoral fractures treated between 1995 and 1999 were retrospectively analysed. The mean age of the patients was 65.7 yrs (range: 40 to 88). All patients were treated with an 11-mm diameter Long Gamma Nail, inserted through a 5-cm incision proximal to the greater trochanter using the antegrade reaming technique. The mean surgical time was 98 minutes (range: 65 to 225). Reliable stability was achieved in all cases and pain relief was excellent. Complications included 2 superficial and 1 deep wound infections, 4 chest infections, 2 urinary tract infections, and 2 deaths in the recovery. Implant failure occurred in one patient and needed revision to a long stemmed total hip prosthesis. The Long Gamma nail offers the advantage of a technically less demanding percutaneous insertion through the tip of the greater trochanter, secure proximal femoral fixation and the ability to allow immediate or early weight-bearing ambulation. Because of these advantages, we recommend the use of the Long Gamma nail for stabilisation of pathologic and impending pathologic fractures of the femur.