The purpose of this study was to assess the referral system, clinical notes and radiographs of patients presenting with metastatic disease of long bones. The study demonstrated that 93% of oncologists did not use a reliable scoring system to assess risk of pathological fracture, and 60% felt an improvement in communication was required. Notes and radiographs were reviewed for 37 patients presenting with femoral metastatic lesions. Sixteen patients had a Mirels' score of greater than 8. Four patients were referred for an orthopaedic opinion. Twelve patients with a score of greater than 8 were not referred; seven of these patients suffered a pathological fracture. Sixteen patients had a Mirels' score of less than 8; none of these patients were referred for an orthopaedic opinion. No pathological fractures occurred. In conclusion, the majority of patients who score above 8 in the Mirels' scoring system are at risk of fracture and do require prophylactic surgery. In keeping with the British Orthopaedic Association (BOA) guidelines, "Metastatic Bone Disease: A Guide to Good Practice", we would recommend a multidisciplinary approach and the use of a recognised scoring system.