Nerve Grafting versus Common Infraclavicular Intraplexal Nerve Transfer in Elbow Flexion Restoration

To compare the results of nerve grafting versus common infraclavicular intraplexal nerve transfer in elbow flexion restoration.

The study included 39 patients with upper brachial plexus palsy who were operated using common intraplexal nerve transfer (Oberlin procedure) and the thoracodorsal and medial pectoral nerve transfer to the musculocutaneous nerve or grafting of C5 to the musculocutaneous nerve, for elbow flexion restoration. All patients underwent detailed preoperative evaluation, which included clinical and neurological examinations, electrophysiological investigation and neuroradiological studies. The final evaluation of achieved recovery of elbow flexion was done two years after surgery, using the British Medical Council scale.

We achieved functional satisfactory recovery (M3, M4, M5) in 29 of 30 patients (96.7%) in the common intraplexal nerve transfer group, and in 4 of 9 patients in the nerve grafting group (44.4.%). There was a significant statistical difference between these two groups in favor of common intraplexal nerve transfers over C5 grafting to the musculocutaneous nerve regarding functional recovery.

The results of our study concur with the findings of previous studies favoring intraplexal nerve transfers over nerve grafting in the restoration of elbow flexion in upper brachial plexus palsy. They reveal that intraplexal nerve transfers are clearly the primary treatment modality in cases of upper brachial plexus palsy without any sign of viable proximal C5 stump presence, while in cases of upper brachial plexus palsy with signs of viable proximal C5 stump the choice of the best treatment modality is still controversial.