Bony metastases are ubiquitous in patients with advanced cancer, and pathologic fractures may occur within either lytic or blastic foci. Approximately 90% of such fractures that require surgical intervention occur in the femur, humerus, or periacetabular pelvis. Techniques for internal fixation or prosthetic replacement have been designed with the realization that destructive bony lysis often extends well proximal and distal to the actual fracture site, and bony union will not occur after irradiation unless absolutely rigid fixation is achieved. Intramedullary fixation using some type of interlocking device, either proximally or distally, is preferable to extramedullary fixation of fractures. The mean postfracture survival for most patients is approximately 2 years.