The restoration of elbow flexion with intercostal nerve transfers

Seventeen patients with absent elbow flexion secondary to brachial plexus avulsion injury underwent intercostal neurotization of the biceps muscle. Followup was performed at an average of 5 years. The average age in this series was 21.8 years; the mean time interval from injury to the surgical procedure was 6 months. Eight of the 17 patients (47%) obtained good or excellent results as defined by Nagano et al. Five patients had muscle function ratings of M2 but were unable to power the elbow against gravity. The overall success rate theoretically may be increased by (1) decreasing the time interval from injury to neurotization to < 5 months; (2) selecting patients < 50 years of age; and (3) using adjuvant surgical procedures after neurotization, including tendon transfers and shoulder arthrodesis, which may improve results from good to excellent.