Background: The most appropriate treatment of pathological fractures from metastatic disease depends on several factors, one of the most important being predicted life expectancy. The aim of this study was to identify the variables that influence prognosis and utilise these to develop a novel scoring system to better predict life expectancy post-pathological fracture. Methods: The records of all patients that presented with metastatic pathological fractures over a 10-year period from the only tertiary orthopaedic departments in Western Australia were retrospectively examined. Variables assessed were primary cancer type, fracture site, fixation method, cement augmentation, pre-morbid level of physical functioning, complication rate, treatment with chemotherapy or radiotherapy and appendicular, spinal and visceral metastatic load. Results: A total of 233 patients were included. Median survival from fracture to death was 4.1months. Median time from cancer diagnosis to pathological fracture was 14.2months. There was a statistically significant association between patient survival and primary cancer type, physical functional score, spinal metastatic burden and use of chemotherapy or radiotherapy. Conclusion: A novel scoring system has been developed that offers a survival probability based on patient's individual circumstances. This can guide specialist management and offer patients a more accurate expectation of functional outcome and survival time.