Abstract
Purpose: To measure the outcomes in patients undergoing nerve transfers for elbow flexion restoration, and compare patient outcomes based on the pre-operative fascicular transfer plan.Methods: Single surgeon series of 48 consecutive patients who underwent median and/or ulnar fascicular nerve transfers for elbow flexion restoration to treat palsies of the brachial plexus or musculocutaneous nerve. Outcomes measured were Medical Research Council (MRC) power grade, strength in kilograms, and time taken to recover function.Results: Overall, 96% of patients achieved MRC M4 or greater power. The subgroup who were planned for, and particularly those who then underwent, double as opposed to single fascicular transfer, had significantly better results.Conclusions: Overall results were excellent. Double fascicular transfers were superior, with no failures in this group. If pre-operatively a single fascicle transfer alone is planned due to a paucity of expendable donors, the predicted outcomes are worse and other treatment options should be considered.
Highlights
Brachial plexus injuries are catastrophic events that predominantly affect the working-age male population, resulting in partial or complete motor and sensory loss in the upper limb
Tendon transfers, and nerve grafts have all been utilized in brachial plexus surgery, but each have significant individual limitations [3,4,5,6,7,8,9,10,11,12]
This study presents a detailed comparison between patients undergoing single or double fascicular nerve transfers for the restoration of elbow function
Summary
Brachial plexus injuries are catastrophic events that predominantly affect the working-age male population, resulting in partial or complete motor and sensory loss in the upper limb. Re-establishing elbow flexion is a major goal of reconstruction in upper plexus injuries [1, 2]. Nerve transfer offers a unique solution, allowing reconstruction away from the zone of injury, and a donor source of axons close to the target muscle. This means that regenerating axons only need to cross a single coaptation, with a shorter distance to target, thereby reducing the extent of motor endplate degeneration whilst awaiting reinnervation [12].
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