Nerve Transfer for Triceps Reinnervation in Obstetrical Brachial Plexus Injury: Long-Term Functional Results

Area of Science:

• Pediatric Orthopedics
• Neurorehabilitation
• Microsurgery

Background:

• Restoring elbow extension is crucial for upper limb function in obstetric brachial plexus injury (OBPI) patients with triceps paralysis.
• Triceps reinnervation is often a secondary surgical consideration in OBPI management.

Purpose of the Study:

• To evaluate the long-term functional results of triceps reinnervation using nerve transfers in pediatric OBPI patients.
• To assess the impact of restoring elbow extension on overall upper limb function and deformity prevention.

Main Methods:

• Retrospective cohort study of 16 pediatric OBPI patients with triceps paralysis.
• Nerve transfers utilized motor branches of the ulnar nerve (flexor carpi ulnaris) and intercostal nerves.
• Outcomes assessed using the Medical Research Council (MRC) scale for strength and Gilbert's Elbow Scale (GES) for function, with a minimum 4-year follow-up.

Main Results:

• Significant improvement in triceps strength (mean MRC 3.75) and elbow function (mean GES 3.75) was observed post-surgery.
• Triceps recovery led to a mean 35-degree reduction in elbow flexion contracture.
• No operative complications or donor site morbidity were reported.

Conclusions:

• Delayed nerve transfers for triceps reinnervation up to age 8 yield satisfactory long-term outcomes in OBPI.
• Restoring elbow extension should be considered a surgical priority in OBPI management, even in complete palsies.
• Nerve transfers offer a viable option for improving function and preventing deformities in affected children.