Abstract
BackgroundRestriction of elbow flexion significantly limits upper extremity function following brachial plexus injuries. In recent years, the double fascicular nerve transfer procedure utilizing ulnar and median nerve transfer to musculocutaneous branches has shown promising functional outcomes.ObjectiveTo evaluate restoration of elbow flexion following a double fascicular transfer in patients with brachial plexus injuries and identify predictors of poor outcomes.MethodsThis retrospective review included 10 consecutive patients with brachial plexus injuries involving C5-C6 root avulsions who underwent the double nerve transfer procedure. The mean follow-up was 12 months and the primary outcome was assessment of elbow flexion with the use of the Medical Research Council (MRC) scale.ResultsThis procedure achieved elbow flexion of MRC grade M3 or higher in 50% of our cohort. Time interval from injury to surgery showed a statistically significant inverse association with functional recovery (r = -0.73, p = 0.016). Patients who had the surgery within six months of the injury, demonstrated higher MRC grades during the follow-up (p = 0.048). There was no association between elbow flexion recovery and age, body mass index (BMI), gender, hypertension, diabetes or smoking status.ConclusionsThe double fascicular transfer to musculocutaneous may be a safe and effective treatment for restoration of elbow flexion. The procedure is associated with superior functional outcomes when performed within the first six months from the injury.
Highlights
Brachial plexus injuries can result in significant physical disability, pain and psychological distress [1]
Patients who had the surgery within six months of the injury, demonstrated higher Medical Research Council (MRC) grades during the follow-up (p = 0.048)
There was no association between elbow flexion recovery and age, body mass index (BMI), gender, hypertension, diabetes or smoking status
Summary
Brachial plexus injuries can result in significant physical disability, pain and psychological distress [1]. The Oberlin procedure consists of an ulnar nerve fascicle transfer to the musculocutaneous branch to the biceps and has since been proven to be a safe and effective procedure for restoration of elbow flexion [5,6]. Several studies have shown that the additional transfer of median nerve fascicles to the motor branch to the biceps may be associated with superior outcomes compared to the traditional Oberlin procedure, without an increase in complication rates [4,7]. The aim of this study is to report restoration of elbow flexion following a double fascicular - ulnar and median to musculocutaneous nerve - nerve transfer after brachial plexus injuries and identify predictors of poor outcomes. Restriction of elbow flexion significantly limits upper extremity function following brachial plexus injuries. The double fascicular nerve transfer procedure utilizing ulnar and median nerve transfer to musculocutaneous branches has shown promising functional outcomes
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