Background and objectives: Eighteen cases of pathological fractures were diagnosed and treated appropriately at Tirtiary care hospital, surat. The study period was from September 2016 to July 2018. The cases were followed up for a period ranging from 2–5 months. Method: 18 cases of pathological fractures were included in this study. The age of the patients ranged from 9–72 years with most of the cases occurring above the age of 45 years. A thorough physical examination along with radiological and laboratory investigations were carried out to find out the cause for the pathological fractures. The initial treatment was generally in the form of bed rest and traction. The final treatment varied with the cause, age of the patient and site of fracture. All cases were followed for a period between 2–5 months. Results: Osteoporosis was the most common cause of pathological fractures (44.4%) followed by tumors (36.11%). Femur (48.71%) was the most common site and most fractures occurred in the trochanteric region. In 91.5% cases the fractures occurred spontaneously or after a trivial injury. Operative treatment was carried out in 72.2% of patients with incidence of failed fixation in 1 cases. Interpretation and conclusion: Typically these fractures occur spontaneously or after a trival injury indicating that the pathological process had compromised the strength of the bone. A thorough physical, clinical, radiological and laboratory investigations is required to find the cause of the pathological weakening of the bone. Whatever treatment protocol is followed to treat the pathological fracture, whether operative or conservative a well planned and executed one dramatically improves the patients life and gives a functionally good result. Patients treated by operative means were ambulatory earlier than those by conservative means.