Outcome after delayed Oberlin transfer in brachial plexus injury

Nerve transfers following traumatic brachial plexus injuries are infrequently operated on after 6 months of injury because myoneural degeneration may set in before nerve regeneration can occur. An exception may lie in transferring healthy donor nerve fascicles directly onto an injured recipient nerve close to the motor point. This is especially true of the Oberlin transfer in which ulnar nerve fascicle(s) are transferred onto the damaged nerve to the biceps.

This retrospective observational study evaluated the outcome of the Oberlin transfer on bicipital power in patients with upper trunk/C5,6,7 root level injuries operated on after 6 months of injury.

Using a standard infraclavicular exposure, the musculocutaneous nerve was followed to its branch to the biceps. Distal to this, the ulnar nerve was skeletonized and a constituent motor fascicle was transferred onto the nerve to biceps. Medical Research Council (MRC) motor power grading was assessed every 3 months following surgery. Patients with a follow-up less than 12 months were excluded.

Nine patients operated on after an average of 12.2 months (range, 7-24 months) following injury qualified for the study. At an average follow-up of 26.7 months (range, 12-41 months), all patients had ≥ 2/5 biceps power. Seven patients (77.8%) had useful biceps function ≥ 3/5 MRC score. A single patient operated on 24 months after injury gained 4/5 MRC biceps power.

The Oberlin transfer is a useful salvage procedure in patients presenting after 6 months of a brachial plexus injury.