Aims: The purpose of our review is to evaluate results of surgical treatment in bone metastases and to relate the surgical indications to these results. Methods: 297 patients operated between 1980 and 1998 were reviewed. Main age of the patients was 60.9 (18–86). The involved bones were femur (169cases), humerus (77), spine (33), tibia (8), pelvis (4), cubitus (2)others (4). The primary tumours (of 215 reviewed diagnosis) were breast (80cases), lung (31), myeloma (21), kidney (18), intestine (8), thyroid (7), prostate (6), uterus (6), pharynx (4), sarcoma (4), bladder (2), liver (2), others (4), well differentiated unknown origin (14), undifferentiated (8). The operations performed were nailing (86cases), interlocked-nailing (59), prosthesis (58), spinal osteosynthesis (34), plating+cement (25) nailing+cement (17), resection (10), resection+cement (6), amputation (2). Minimal conditions for surgery were life expectancy of at least 60 days, possibility of a solid implant and acceptable blood parameters (wbc> 2,000, plt> 30,000). Most of the patients underwent postoperative radiotherapy. Results: The Karnofsky index at sixty days showed a mean improvement of 30pts% using nails and prosthesis, and 10pts% with plating+cement (performed in patients in better general conditions). After surgery, all of the patients reached a score over 70pts% and in every case pain was sensibly reduced. There were 3 perioperative deaths (1%) and 10 major complications (3.4%). Conclusions: An operation performed after an accurate planning leads to an improvement in the quality of life and self-sufþciency of these patients, thereby reducing the cost of care. The choice of technique must allow to obtain a quick result (no bone grafting) and a fast functional improvement, considering the limited life expectancy of the patients.