Oncology patients are at risk of developing bone metastases that frequently result in destructive lesions of the skeleton. Treatment options for patients diagnosed with metastatic bone disease depend on the primary cancer site, presence of pain, and fracture risk. Typically, surgical intervention is the best form of management for impending or actual pathologic fractures of long bones because they are associated with considerable mortality. The purpose of this clinical article is to describe the pathogenesis of bone metastases and review the clinical presentation and evaluation. The surgical management of impending and actual pathologic fractures is reviewed with an emphasis on evaluating the risks and benefits associated with the surgical treatment of the femur. Nursing implications for patient assessment, monitoring, and education to minimize the risk of postoperative complications are presented.