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Distal Nerve Transfers for Elbow Flexion in Infants with Obstetric Brachial Plexus Injuries: Clinical Outcomes
Amy M. Moore, MD; David Shin, BS; Robert J. Spinner, MD; Allen T. Bishop, MD; Alexander Y. Shin, MD
Mayo Clinic, Rochester, MN, USA
Background: Obstetric brachial plexus injuries can lead to significant impairment in upper extremity function. Historically, these injuries have been treated with intraplexal nerve grafting. In cases of upper root avulsion, grafting may not be possible for restoring critical elbow flexion, and conventional nerve transfers are typically performed (intercostal and/or spinal accessory nerve donors). The purpose of this study was to evaluate the outcomes of distal nerve transfers for restoration of elbow flexion in infants with upper trunk birth palsies.
Methods: A retrospective review (2000-2010) identified nine patients with upper obstetric brachial plexus injuries who received distal nerve transfers to restore elbow flexion. The average age at operation was 6 months (range, 3.5-15.5 months). All patients underwent fascicle transfers of a functioning ulnar or median nerve to the biceps and/or brachialis branches of the musculocutaneous nerve (i.e. Oberlin’s transfer). Elbow range of motion and hand function were evaluated and recorded at 6, 12, and 18 months, and at final follow-up.
Results: Eight of nine patients were available for follow-up. Mean follow-up was 49 months (range, 15-130 months). At final follow- up, six patients achieved M4 or greater elbow flexion with a mean arc of motion of 132 degrees (range 120-135 degrees). The patient who underwent surgery at 15 months achieved M3 elbow flexion. One patient failed to achieve functional elbow flexion by 15 months. No deficits of hand function or wrist flexion were noted in any patient.
Conclusions: Distal nerve transfers to restore elbow flexion are a viable option in upper obstetric brachial plexus injuries. They offer potential benefits over traditional nerve transfers and should be considered in patients with complete upper trunk avulsions.
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