Background: Functional muscle transfer (FMT) can provide wound closure and restore adequate muscle function for patients with oncologic extremity defects. Herein we describe our institutional experience with FMT after oncological resection and provide a systematic review and meta-analysis of the available literature on this uncommon procedure. Methods: A single-institution retrospective review was performed, including all patients who received FMT after oncological resection from 2005-2021. For the systematic review and meta-analysis, PubMed, Cochrane, Medline, and Embase libraries were queried according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines; results were pooled, weighted by study size, and analyzed. Results: The meta-analysis consisted of seven studies with 70 patients overall, demonstrating a mean MRC score of 3.78 (95% CI, 2.97-4.56; p < 0.01). The systematic review included 28 studies with 103 patients. Receipt of adjuvant chemotherapy was associated with significantly lower mean MRC score (3.00 ± 1.35 vs. 3.90 ± 1.36; p = 0.019). Seventy-four percent of the patients underwent free FMT, with the most common donor muscle being the latissimus dorsi (55%). The flap loss rate was 0.8%. Neoadjuvant chemotherapy (p = 0.03), radiotherapy (p = 0.05), pedicled FMTs (p = 0.01), and a recipient femoral nerve (p = 0.02) were associated with significantly higher complication rates. The institutional retrospective review identified 13 patients who underwent FMT after oncological resection with a median follow-up time of 21 months (range, 6-74 months). The most common tumor necessitating FMT was undifferentiated pleomorphic sarcoma (77%), and the most common donor muscle was the latissimus dorsi (62%). A high body mass index was associated with prolonged neuromuscular recovery (R = 0.87, p = 0.002). Conclusion: FMT after oncological resection may contribute to improved extremity function. Careful consideration of risk factors and preoperative planning is imperative for successful FMT outcomes.

Introduction: Given the relative rarity of tibial tubercle fractures and the high proportion that undergo surgical treatment, there is little data on non-operative management of these injuries. Some patients that are initially treated non-surgically may ultimately require operative intervention. The purpose of this study was to identify risk factors for failed non-operative management of tibial tubercle fractures. Methods: This retrospective comparative study included patients younger than 18 years that underwent initial non-operative treatment of a tibial tubercle fracture at six tertiary children’s hospitals. Those that underwent primary surgical intervention were excluded. Demographic, radiographic, and clinical data were reviewed. Conversion to surgical fixation was considered a failure of non-operative treatment. Univariable analysis was followed by multivariate regression to adjust for confounders. Results: A total of 136 patients were included, of which 19.1% failed non-operative treatment and subsequently underwent surgery. The median age of patients that ultimately required surgery was 14.0 y [IQR (interquartile range) 2.5 y] compared to 12.0 y (IQR 2.0 y) for those that were successfully managed without surgery. Non-operative treatment failed in 7.8% of Ogden type I fractures, 66.7% of type II, 81.8% of type III, 35.7% of type IV, and 7.1% of type V (p<0.001). After adjusting for confounders, including weight and initial weight-bearing status, each year of increasing age raised the odds of failure by 1.9 (95% CI 1.2-3.0, p=0.006). Additionally, Ogden type II fractures had 23.4 times higher odds than type I (95% CI 2.1-260.8, p=0.01). Ogden type III fractures had 36.3 times higher odds of failing non-operative treatment than type I (95% CI 4.2-315.4, p=0.001). Conclusion: In this study of patients with a tibial tubercle fracture initially treated non-operatively, 19.1% ultimately underwent surgery. Increasing age and Ogden type II and III fracture classification were associated with failure of non-operative management. These results may help guide decision-making regarding surgical versus non-surgical treatment. Significance: There is little data on non-operative treatment of tibial tubercle fractures. This study identifies risk factors for failure of non-operative treatment and may aid clinical decision-making.