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Background: Simple/unicameral bone cyst (SBC) is a common bone lesion found especially in the pediatric population often diagnosed incidentally on X-ray or due to a pathological fracture. Most of such fractures require curettage with or without fixation depending on fracture stability. Those that require fixation may pose an issue to post-operative surveillance of cyst recurrence due to the stress shielding phenomenon. Case report: We present a case of a pathological subtrochanteric femoral fracture on the background of an SBC in a 6-year-old boy. Curettage of the lesion and surgical fixation of the femur were performed for the patient with favourable outcomes. Conclusion: Pathological fractures of SBCs that need fixation should be have a less rigid fixation with the intent of allowing better visualization/monitoring under CT scan to better allow surveillance of cyst recurrence, and also reduce the effect of stress shielding.