Distal Nerve Transfers in Restoration of Elbow Flexion and Hand Functions in Brachial Plexus and Peripheral Nerve Injuries

Abstract

Background: Surgical management of brachial plexus and peripheral nerve injuries remain a challenging problem. The focus of peripheral nerve surgery is gradually shifting form nerve graft recon-struction to distal nerve transfers. Distal nerve transfers have become the standard of care in brachial plexus and high peripheral nerve injuries in many centres. The authors describe their experience in distal nerve transfers for restoration of elbow flexion and hand functions in brachial plexus and high peripheral nerve injuries.

Material & Methods: 14 patients with brachial plexus injuries and high peripheral nerve injuries underwent reconstruction to restore elbow flexion and hand functions. The mean age was 31 years (range 22-43) and mean time to surgery after injury was 7.7 months. Follow up averaged 18 months.

Results: Good to excellent recovery (more than M4 power) was seen in 5 of 7 patients in bifasicular nerve transfers for elbow flexion and in 2 patients with high radial nerve injury. Of 3 cases with ulnar nerve injury nerve transfers resulted in good key pinch function in two patients and satisfactory pinch function in one. Both patients with high median nerve injury and lower brachial plexus injury had post operative poor finger flexion.

Conclusion: Distal nerve transfers must be considered for useful restoration of elbow flexion in upper brachial injuries as also in patients with high peripheral nerve and lower brachial plexus injuries for improving hand function.