A series of twenty-three pathological fractures in nine children who had Gaucher disease was reviewed. Infiltration of the medullary space by Gaucher cells, erosion of bone, osteonecrosis in the area of the fracture, and disuse osteoporosis were the main etiological factors. Bone scans indicated that the osteonecrosis was due to osseous ischemia that occurred two to twelve months before the pathological fracture. Fracture-healing was prolonged, taking as long as two years for completion in some patients. Inadequate periods of immobilization and early weight-bearing led to malunion.