Timing of nerve transfer for elbow flexion in neonatal brachial plexus palsy

Abstract

BackgroundNeonatal brachial plexus palsy (NBPP) occurs in 1–4/1000 live births, and those with palsies of the upper trunk can suffer permanent loss of elbow flexion. One option for restoring elbow flexion comprises nerve transfer from an ulnar nerve fascicle to the musculocutaneous nerve branch to biceps, also known as the Oberlin procedure. Although outcomes are encouraging, the timing of surgical intervention from the time of injury continues to be controversial. MethodsWe performed a retrospective review of infants with NBPP who underwent Oberlin transfer procedure. Outcome measures included active range of motion and muscle power (MRC grade) at serial examinations up to 12 months. ResultsWe demonstrate a positive trend in outcomes of elbow flexion and supination in patients intervened on earlier rather than later. ConclusionsThe optimal timing in the use of Oberlin transfer in the NBPP population is not well defined. Our study is the first to focus on ulnar to musculocutaneous nerve transfer timing in NBPP, and we demonstrate a positive trend in functional outcomes with earlier surgery.