Outcomes From Radial Fascicular Nerve Transfers Including Extensor Carpi Radialis Longus to Triceps for Elbow...

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Microsurgery

Background:

• Restoring elbow extension is crucial after brachial plexus injuries.
• Previous nerve transfer techniques for triceps reinnervation have yielded inconsistent results.
• Radial fascicular transfers targeting extensor carpi radialis longus (ECRL) warrant investigation for elbow extension restoration.

Purpose of the Study:

• To evaluate the efficacy of radial fascicular transfers using ECRL donor fibers for restoring elbow extension in patients with brachial plexus palsy.
• To assess the safety and functional outcomes of this nerve transfer technique.

Main Methods:

• A single-surgeon case series included four patients with traumatic brachial plexus palsies and complete triceps weakness.
• Radial fascicles, primarily from ECRL, were coapted to motor branches of the triceps.
• Patients underwent microsurgical nerve transfers and were followed for a mean of 19 months, assessing elbow extension strength and range of motion.

Main Results:

• All four patients regained functional elbow extension.
• Final elbow extension strength was Medical Research Council (MRC) grade ≥ 4/5 in all cases.
• Excellent active range of motion was achieved with no donor-site deficits or complications.

Conclusions:

• Radial fascicular transfers using ECRL donor fibers are a safe and effective method for restoring elbow extension.
• This technique is a viable option for patients with brachial plexus palsy and triceps palsy, provided wrist extensor function is preserved.