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Pathological fractures, both completed and impending, of the humeral diaphysis from primary or metastatic disease demand a reconstruction that restores stability while preserving shoulder function and alleviating pain. Conventional reconstructive approaches include the use of long-stemmed endoprosthetic devices, plate-and-screw fixation or intramedullary nailing, all of which can be limited in their success when residual bone is short or biologically weak. This case study details the management of a patient with metastatic leiomyosarcoma who presented with refracture through a previously cement-augmented lesion. Following resection, the diaphyseal defect was spanned using a custom humeral cage. A NuVasive PRECICE magnetically controlled intramedullary nail, pre-lengthened before insertion, was placed through the cage and shortened intraoperatively to achieve axial compression between the cage and bone segments. At the 6 month follow-up, the patient had excellent shoulder range of motion, apparent ingrowth into the cage, and he was able to resume activities of daily living with minimal pain.