We present the case of a 58 year old man who presented with a pathological fracture of his right humerus. Further investigations revealed he had IgA multiple myeloma. A skeletal survey showed lytic lesions in his contralateral humerus and both femora. He was treated with the insertion of intramedullary nails to both humeri and both femora, in addition to undergoing systemic therapy for his myeloma. This paper reports, for the first time, the use of four intramedullary nails in the same patient and examines the principles behind the management of pathological bone disease.