gms | German Medical Science

Objective: One of the main goals in brachial plexus surgery is the reconstruction of elbow flexion. At present the preferred surgical treatment is the reconstruction with autologous nerve grafts. In case of root avulsions nerve transfers are considered optional. Current literature lacks evidence supporting a preferred treatment option. We compared the outcome of the different methods for reconstitution of elbow flexion.

Method: A retrospective analysis of cases was conducted. 108 patients with traumatic brachial plexus injury who underwent surgery for restoration of elbow flexion in our institute from 01/2002 to 12/2011 were identified. Ten patients were lost to follow-up. We divided the patients in five groups: Reconstruction by: Group 1: autograft to musculocutaneus nerve (MCN) (11 patients)/ Group 2: autograft to fasciculus lateralis (11 patients) / Group 3: combination of autograft with nerve transfer to MCN (16 patients) / Group 4: Oberlin transfer (24 patients) / Group 5: transfer of spinal accessory nerve to MCN (36 patients).

Results: Within the whole collective a functional elbow flexion (M3) was regained by 49%. Group 1: recovery to M3: 54% / Group 2: 45% received M3 / Group 3: recovery to M3 in 43% / Group 4: M3 in 80% / Group 5: 31% received M3. The outcome of group 4 (Oberlin procedure) was significantly (p=0,012) better to the other groups.

Conclusions: Contrary to the standard therapy regime of applying autologous graft repair when feasible, the outcome of patients with Oberlin transfer as a stand alone nerve transfer for elbow flexion was significantly (p=0,012) better as the outcome of stand alone nerve repair or combined methods. Is there a need to adapt treatment algorithms for brachial plexus repair?