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Purpose: Bone morphogenetic proteins (BMPs) belong to the transforming growth factor-β (TGF-β) superfamily of proteins; they were initially named after their ability to induce ectopic bone formation. Published studies have proved BMPs' role in a variety of biological processes such as embryogenesis and patterning of body axes, and maintaining adult tissue homeostasis. Other studies have focused on BMPs properties, functions and possible involvement in skeletal diseases, including cancer., Methods: A literature search mainly paying attention to the role of BMPs in musculoskeletal tumors was performed in electronic databases., Results: This article discusses BMPs synthesis and signaling, and summarizes their prominent roles in the skeletal system for the differentiation of osteoblasts, osteocytes and chondrocytes., Conclusions: The review emphasizes on the role of BMP signaling in the initiation and progression of musculoskeletal cancer.

Bone loss from trauma, neoplasia, reconstructive surgery and congenital defects remains a major health problem. The long-term clinical goal is to reconstruct bony tissue in an anatomically functional three-dimensional morphology. In the extremities, bone grafts are used for the treatment of non-unions and necrotic lesions, for skeletal structural support and for the reconstruction of defects resulting from trauma, tumor excision, osteomyelitis, congenital pseudarthrosis, or radiation necrosis. In all cases their use is successful provided that the host bed has adequate vascularization. In cases of decreased blood supply, a vascularized bone graft should be applied. The intrinsic blood supply of the vascularized bone grafts leads to higher success rates and to acceleration of the repair process in the reconstruction of defects and necrotic lesions of the skeleton., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Skeletal osteochondromas or osteocartilaginous exostoses represent the most common of all benign bone tumors and 10% to 15% of all bone tumors. Osteochondromas are solitary or multiple, pedunculated or sessile exophytic outgrowths from the bone surface that are composed of cortical and medullary bone with an overlying hyaline cartilage cap. Marrow and cortical continuity with the underlying parent bone defines the lesion. Osteochondromas usually occur in children or adolescents between 10 and 15 years, and increase in size throughout childhood, ranging from 1 to 10 cm. After adolescence and skeletal maturity, osteochondromas usually exhibit no further growth. In adults, growth or imaging alterations of an osteochondroma suggest the rare diagnosis of malignant transformation; however, extensive growth of osteochondromas without histological evidence of malignancy has been reported

Pathological fractures in patients with primary bone sarcomas should not be considered an absolute indication for amputation. Initial fracture management should include cast immobilisation or external fixation avoiding tumour-cell dissemination. The extent of fracture displacement and the type of fracture stabilisation may affect the outcome of patients with primary bone sarcomas presenting with pathological fractures. Patients with high-grade primary bone sarcomas should be treated by neo-adjuvant chemotherapy, and limb-salvage surgery. Pathological fractures in chemo-resistant primary bone sarcomas are a relative contraindication for limb salvage surgery.

A very unusual location of osteoid osteoma arising in the radial styloid is presented, which strongly mimicked de Quervain tenosynovitis, thereby resulting in the patient undergoing an additional unnecessary operation and a substantial delay of more than 2 years in diagnosis.

A 14-year-old girl with a Ewing's sarcoma of the left femoral head and neck is presented. The imaging features mimicked a benign cystic lesion. Biopsy and molecular analysis confirmed the diagnosis. The patient was treated with chemotherapy, wide tumor resection, and proximal femoral reconstruction using an allograft-prosthesis composite. Differential diagnosis, imaging, and pathologic features of Ewing's sarcoma are discussed.

Advances in systemic treatment of cancer have improved patients' survival and increased the number of patients presenting with metastases of the pelvic ring. Pelvic metastatic lesions may cause severe pain and functional disability. A multidisciplinary approach is fundamental for the management of these lesions. Lesions of the pelvis not directly involving the hip joint such as the ischium, pubis or sacroiliac area can generally be treated non-operatively with radiation alone or using minimally invasive procedures of radiofrequency ablation, cryosurgery and percutaneous osteoplasty. Periacetabular destructive lesions may require total hip replacement with reconstruction of the acetabulum dependent on the extent of the defect. Operative treatment should restore the mechanical stability of the hip joint, and preserve the mobility, independence and comfort of these patients.

Image-guided percutaneous thermal ablation is a safe and effective method to reduce pain in patients with painful bone tumors. Computed tomography-guided radiofrequency or laser ablation is the modality of choice for most osteoid osteomas. Radiofrequency or laser thermal ablation also offers an alternative method for palliation of localized, painful osteolytic metastatic lesions. Pain can be reduced and neural damage prevented, improving the quality of life for patients with cancer who often have multimorbid conditions and limited life expectancy. A multidisciplinary approach that includes orthopedic surgeons, neurosurgeons, medical and radiation oncologists, and interventional radiologists is essential to manage these patients.

Nourished by the peroneal vessels, the versatile free vascularized fibular graft can be transferred to reconstruct skeletal defects of the extremities. It may be combined with skin, fascia, muscle, and growth-plate tissue to address the needs of the recipient site. It may be cut transversely and folded to reconstruct the length and width of tibial or femoral defects. The main indications for this graft are defects larger than 5 to 6 cm or with poor vascularity of the surrounding soft tissues. Detailed preoperative planning, experience in microvascular techniques, and careful postoperative follow-up are necessary to minimize complications and improve outcome. The free vascularized fibular graft has been successfully applied as a reconstruction option in patients with traumatic or septic skeletal defect, after tumor resection, and has shown promise in patients with congenital pseudarthrosis.