Orthopaedic surgeons are increasingly confronted with metastatic fractures. As the majority of metastatic fractures never heal, surgical treatment is required. The goals of surgical therapy are to achieve early mobilization, relief pain and improve quality of life. One hundred twenty nine patients with 160 metastatic fractures of a long bone, completed or impending, were retrospectively analysed with regard to the type of treatment, effect on pain relief and mobility. Seven of the patients (4.4%) died postoperatively, a good functional result was obtained in 86.9% of the cases and for all patients a good analgesic effect was achieved. In 3.75% of the cases a mechanical complication was seen which needed reintervention. In general, the only indication for endoprosthesis is an intracapsular or very proximal lesion. In almost all other cases, intramedullary nailing is preferred.