Search

Background. Brachymetatarsia is defined by an abnormal shortening of the metatarsal bone. This rare condition is mostly primary and congenital. Consequences of this malformation are both esthetic and functional, due to pain and mechanical problems in the forefoot. Surgical management is an important part of patient care. There are two main options: gradual lengthening by progressive callotosis distraction using an external fixator and one stage lengthening using bone graft and osteotomy of the bone. This review presents two cases using the one stage lengthening surgical management method. We also discuss some reports in the literature with the aim to compare the advantages and disadvantages of the two surgical methods. Literature concerning the surgical management of brachymetatarsia was identified using the PubMed and Google Scholar databases. Patient Presentation. We describe two female patients aged 20 and 26 years who underwent one stage lengthening surgery of the fourth toe with isolated brachymetatarsia using an iliac bone graft and internal fixator plate. The two patients had a lengthening of around 10 mm after postoperative evaluation. No skin complications were noted, but one of the patients reported flexor stiffness after surgery. Concerning the functional and cosmetic aspects, the two patients are satisfied with the management. Conclusions. In the literature, one stage lengthening seems to be the most favorable option for the care of brachymetatarsia. Studies show a short healing time and fewer complications like infection, stiffness, malalignment, and malunion. Some reviews note the utility of the gradual lengthening of severe brachymetatarsia when a longer lengthening is necessary. There is no definite consensus concerning the management of brachymetatarsia.

International audience

Additional file 1. RT-PCR analysis of MSCs differentiation

Additional file 2. Osteogenic differentiation of MSCs issued from human bone marrow (BM-MSCs), from the human synovial membrane (SM-MSCs) and fluid (SF-MSCs) at D14 without (OSTEO-) or with osteogenic medium (OSTEO+). Adipogenic differentiation of MSCs issued from human bone marrow (BM-MSCs), synovial membrane (SM-MSCs) and synovial fluid (SF-MSCs) at D21 without (ADIPO-) or with adipogenic medium (ADIPO+)

Additional file 4. The senescence was evaluated using a kit "senescence β galactosidase staining kit" according to the manufacturer's recommendations (Cell Signaling Technology)

Additional file 3. Von Kossa staining at D28 of collagen sponges seeded with advanced OA human BM, SM- and SF-MSCs under ITS and TGF-β1

International audience

International audience

International audience

Cartilage lesions can be divided into focals defects caused dy trauma or osteochondritis and into diffuse lesions caused by osteoarthritis (OA). To study the kinetics of degeneration of the articular cartilage during OA, we investigated the clinical and histological events during the early phases of experimental, mechanically-induced OA in the rat induced by anterior cruciate ligament transection (ACLT). The lesions developed in this model are similar to those observed in clinics. In a second step we investigated the influenjce of several parameters on the course of the model : calibrated effort, intra-articular injection of a proteasome inhibitor (MG 132) and intra-articular injection of hyaluronate.The relationship between sport and osteoarthritis is still debated in the literature but the intensity of physical activities seem to be one of the most important factor in the developpement of OA. We demonstrated in our study that a moderate exercise can limit the severity of chondral lesions after ACLT, in part via an overexpression of an atni-apoptotic factor, Hsp 70. We also demonstrated the chondoprotective effect of a proteasome inhibitor MG 132 andof hyaluronate in our model. In a second step, we developed the culture of primary bovine chondrocytes in collagen gels for cartilage engineering. Our results suggest that primary bovine chondrocytes cultured in collagen gel grew in 3 dimensions, accumulating an extra cellular matrix while maintaining their phenotype during 2-week culture periods. In summary, the chondoprotective effect via an over expression of Hsp70 seems to be useful to prevent cartilage damages and OA. Tissue engineering using collagen gel scaffolds constitutes a new approach to treat cartilage defects., Les lésions du cartilage peuvent être divisées en lésions focales observées au décours de traumatismes articulaires ou lors d' ostéochondrites disséquantes et en lésions étendues diffuses présentes dans l'arthrose. Dans un premier temps, nous avons développé un modèle d'arthrose par section du ligament croisé antérieur (LCA) chez le rat. Ce modèle dit mécanique par opposition au modèle structural a été caractérisé sur le plan histologique et immunohistochimique. Il reproduit les lésions d'arthrose observées en clinique et s'avère donc un modèle particulièrement intéressant. Nous avons ensuite étudié l'influence de différents paramètres sur ce modèle: effort, injection intra-articulaire d'un inhibiteur du protéasome et injection intra-articulaire d'acide hyaluronique. Le lien entre activité physique et arthrose est controversé dans la littérature mais il semble que l'intensité de l'effort soit l'un des facteurs prédominants dans la survenue ou non des lésions cartilagineuses. Nous avons ainsi pu démontrer qu'une activité physique modérée permettait de limiter les lésions cartilagineuses. Nous avons ainsi pu démontrer qu'une activité physique modérée permettait de limiter les lésions cartilagineuses après section du LCA. Cette action bénéfique semble liée à la surexpression d'Hsp70 et à la diminution des phénomènes apoptotiques. L'injection d'un inhibiteur du protéasome, le MG 132, est capable également de diminuer la sévérité des lésions histologiques provoquées par la section du LCA, via l'induction de la protéine Hsp70. Enfin, nous avons démontré l'effet bénéfique de la viscosupplémentation sur les lésions cartilagineuses de notre modèle. Dans une seconde approche; nous avons développé in vitro une technique de culture de chondrocytes en 3 dimensions au sein de gels de collagène afin de synthétiser un néocartilage. Nos résultats démontrent la faisabilité de cette technique, sa reproductibilité tout en maintenant le phénotype chondrocytaire. Elle pourrait représenter une alternative à la technique classique dite de Brittberg dans les années à venir.Nos résultats montrent au total d'une part l'intérêt de la surexpression de la protéine Hsp70 pour obtenir un effet chondroprotecteur et prévenir ou limiter les lésions arthrosiques et d'autre part les possibilités de réparation des lésions ostéochondralés localisées par la culture chondrocyt:iire en gels de collagène in vitro.