Three-column theory in the clinic treatment of tarsometatarsal joint injuries

Abstract

Objective To investigate how the three-column theory can be applied in the treatment of injuries of the tarsometatarsal joint. Methods From January 2003 to April 2008, 38 patients with fracture-dislocation of the tarsometatarsal joint were treated, including 11 open injuries. According to anatomical three-column classification, 5 cases involved the single medial column, 13 the medial and middle columns, 8 the middle and lateral columns, 5 the single lateral column, and 7 the three columns. The fractures were complicated with the scaphoid in 6 cases, the cuboid in 5, the cuneiform in 12, and the metatarsal in 21. Hollow screws or plates were used to fix the tarsometatarsal joint depending on the severity for closed injury, and K-wires with or without a micro-external fixator for open injury. Results All patients had a mean follow-up of 16.5 months (range, 12 to 25 months) . All the wounds healed primarily except 2 open cases that had to receive flap reconstruction due to wound infection. Radiological evaluation demonstrated that 30 cases restored anatomic configuration of the three columns and transverse arch, but 8 showed flatfoot deformity and 7 complained of pain after removal of implants. Evaluation by Hardcastal functional and radiological scoring system showed 18 excellent cases, 11 good ones, 5 fair ones and 4 poor ones, with a good to excellent rate of 76. 3%. Conclusions The three-column theory can provide significant guidance for clinical practice. The medial and middle columns need to de reconstructed and fixed firmly, and the lateral column needs elastic fixation. The cuneiform and cuboid bones must be reconstructed as well. Key words: Foot injuries; Fracture fixation, internal; Tarsometatarsal joint; Three-column theory