To compare the efficacy of percutaneous long bone cementoplasty (PLBC) with and without embedding a cement-filled catheter in the medullary canal (ECFC) for painful long bone metastases with impending fracture. A retrospective study was conducted in 36 consecutive patients undergoing PLBC and ECFC combination (n = 17, group A) or PLBC alone (n = 19, group B). All patients had a high risk of impending fracture in the long bone based on Mirels' scoring system. Clinical effects were evaluated using both a pre- and a postoperative visual analogue scale (VAS) and Karnofsky performance scale (KPS). Overall pain relief rate with excellent (VAS 0-2) and good (VAS 2.5-4.5) results during follow-up was significantly higher in group A than in group B (88.2 % vs. 57.9 %, P < 0.05). The average VAS and KPS changes in group A were significantly higher than those in group B at 1, 3 and 6 months postoperatively (P < 0.05). Also, the rate of fractures of the treated long bone in group A was significantly lower than that in group B (P < 0.05). Combined PLBC and ECFC is a safe and effective procedure for long bone metastases with impending fracture. aEuro cent Metastases in long bones may cause pain and subsequent pathological fractures. aEuro cent Cementoplasty resulted in significant pain relief in patients with long bone metastases. aEuro cent Combination of PLBC and ECFC may reduce the incidence of fractures.