Impact of Surgery Timing on Outcomes After Nerve Transfer to Restore Elbow Flexion

Nerve reconstruction following brachial plexus injury (BPI) is a time-sensitive procedure, and surgical delay may negatively impact muscle reinnervation and outcomes. This study investigated the impact of surgical timing on elbow flexion strength in patients with BPI undergoing nerve transfer to restore elbow flexion.

Following PRISMA guidelines, MEDLINE, Embase, and the Cochrane Library databases were systematically searched. English-language studies investigating the single fascicular transfer (SFT) or double fascicular transfer (DFT) to restore elbow flexion in BPI were included. Data were analyzed to identify the predictors of elbow flexion strength: surgery timing, age, injury level, and SFT versus DFT.

The literature search identified 1051 articles. Studies (n = 31) reporting data of individual patients who underwent SFT (n = 341) or DFT (n = 67) were included; the mean age was 29.6 ± 11.2 years, time from injury to surgery was 6.5 ± 5.0 months, and follow-up was 27.1 ± 24.3 months. Good elbow flexion strength was found: Medical Research Council grade greater than or equal to 3 in 352 (86.3%) and Medical Research Council grade greater than or equal to 4 in 288 (70.6%). In the adjusted analysis, poorer motor recovery was associated with increased age (P = 0.02), surgical delay (P < 0.0001), C5-7 injuries (P < 0.01), and pan-plexus injuries (P < 0.0001). A 32% reduction in the odds of favorable motor recovery was observed with a 3-month delay to surgery. Patients who had a nerve transfer 6 months or earlier from injury had 2.4 times the odds of favorable motor recovery (P < 0.001).

SFT and DFT provide excellent elbow flexion strength in the majority of patients. Following nerve transfers in individuals with BPI, poorer motor recovery was observed with each 3-month delay to surgery.