Objective To analyze the curative effect of neoadjuvant chemotherapy combined with limb salvage for osteosarcoma with pathologic fracture.Methods The cases were divided into combined group (68 cases of osteosarcoma with pathologic fracture who received limb salvage after neoadjuvant chemotherapy),non-chemotherapy group (22 cases of osteosarcoma with pathologic fracture who received operation without concurrent chemotherapy or chemotherapy only after operation),non-fracture group (48 cases of osteosarcoma without synchronous pathologic fracture who received limb salvage after neoadjuvant chemotherapy) and amputation group (32 cases of osteosarcoma combined with pathologic fracture who received amputation).Survival rate,local recurrence rate,metastasis rate and quality of life were compared between groups.Results Average estimated survival period of the combined group was obviously longer than that of the non-chemotherapy group (P ＜ 0.05),but had no significant difference from the non-fracture group or amputation group.Of the 5-year survival rate between groups,the combined group was evidently higher than the non-chemotherapy group (P ＜ 0.05),but without significant difference from the non-fracture group or amputation group.Whereas,non-chemotherapy group showed a lower 5-year survival rate than the amputation group or non-fracture group (P ＜ 0.05).Localized recurrence rate and metastasis rate of the combined group were markedly decreased when compared to the nonchemotherapy group (both P ＜ 0.01),but were not significantly different from the non-fracture group or the amputation group.The combined group showed a significantly higher score of social function than the amputation group (P ＜0.01),a significantly higher score of biological pofession than the non-chemotherapy group or the amputation group (P ＜ 0.05),and a significantly higher score of general health than the nonchemotherapy group (P ＜ 0.05).However,no significant differences were observed between groups regarding the scores for other items.Conclusion New adjuvant chemotherapy combined with limb salvage is a rational treatment of osteosarcoma with pathologic fracture for it saves the limb after the guarantee of survival rate without increasing the localized recurrence rate or metastasis rate,and improves quality of life.