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ORIGINAL ARTICLE
Year : 2019  |  Volume : 9  |  Issue : 1  |  Page : 55-59

Optimal nerve transfer for elbow flexion restoration in brachial plexus injuries: An analysis of postoperative recovery


1 Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, NY; Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
2 Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, New York, NY, USA
3 Healthcare Research Institute, Hospital for Special Surgery, New York, NY, USA

Correspondence Address:
Dr. Eliana B Saltzman
Department of Orthopaedic Surgery, Duke University Medical Center, Box 3000, Durham, NC, 27710
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/DORJ.DORJ_8_19

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Aim: Following upper brachial plexus injury, one of the primary goals of reconstruction is reinnervation of elbow flexion (EF). Various reconstruction methods have been described including ulnar nerve fascicle and/or median nerve fascicle transfer to the musculocutaneous biceps brachii motor branch and/or the brachialis motor branch. However, there is no study that analyzes the efficacy of one set of transfers to another. We aim to determine if there are improved outcomes with the ulnar nerve transfer to biceps branch and median nerve transfer to brachialis branch (UBB/MBr, Group 1) compared to ulnar nerve transfer to brachialis and median nerve transfer to biceps branch (UBr/MBB, Group 2). Methods: We performed a retrospective analysis of 12 patients who sustained C5–C6 ± C7 brachial plexus injuries and underwent nerve transfers for EF reconstruction. All clinical and electromyographic (EMG) data were captured for an average follow-up time of 35 months. Data were analyzed using a generalized estimating equation model (P < 0.05). Results: Seven and five patients were included in Groups 1 and 2, respectively. At 6 months, Group 2 achieved a greater Medical Research Council score of global elbow function 4 versus 1.5 (P < 0.05), biceps strength 3.67 versus 2.13 (P < 0.05), and brachialis strength 3.5 versus 2.5 (P < 0.05). The brachialis EMG recruitment pattern also demonstrated improved results in Group 2 as compared to Group 1 at 12, 24, and 36 months (P < 0.05). Conclusion: These findings indicate that UBr/MBB nerve transfer confers significantly faster recovery of global EF, biceps, and brachialis strength at 6 months. Although differences in strength equalized by 24 months, EMG data demonstrated increased muscle nerve potential in Group 2 at 12 months and beyond. Clinical Significance: The median nerve fascicle transfer to the biceps branch and ulnar nerve fascicle transfer to brachialis branch appear to have advantages in EF function.


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