title: Oberlin's ulnar nerve transfer to the biceps motor nerve in obstetric brachial plexus palsy: indications, and good and bad results.
abstract: We present 7 children with obstetric brachial plexus palsy treated by transferring two motor fascicles out of the ulnar nerve to the biceps nerve. Three were male, and 4 were female. The left-side brachial plexus was affected in 4 patients, and the right side in 3 patients. All children had vaginal delivery; two of them presented with shoulder dystocia. The average birth weight was 4300 g (range, 3620-5500 g). Average age at time of operation was 16 months (range, 11-24 months). The indication for the operation was absent active elbow flexion with active shoulder abduction against gravity in 4 cases, and no biceps function and bad shoulder function in 3 cases. Oberlin's ulnar nerve transfer was done in 4 cases without brachial plexus exploration in those children with good shoulder function, and exploration of the brachial plexus was performed in the other 3 cases with bad shoulder function. The average follow-up was 19 months (range, 13-30 months). Five children had biceps muscle >or=M(3) with active elbow flexion against gravity, and 2 children had biceps muscle <M(3). We recommend Oberlin's ulnar nerve transfer for upper-type obstetric brachial plexus palsy in 1). breech delivery with avulsion of C5 and C6 nerve roots,) late presentation with good recovery of shoulder function, and 3). neuroma-in-continuity of the upper trunk with intraoperative good nerve conduction for the shoulder muscles, the same as preoperative good shoulder function but with no biceps action.
authors.affiliation: Reconstructive Surgery Unit, Franziskus Hospital, Aachen, Germany.
authors.forename: Hassan Hamdy
authors.initials: HH
authors.lastname: Noaman
authors.forename: Anis Elsayed
authors.initials: AE
authors.lastname: Shiha
authors.forename: Jörg
authors.initials: J
authors.lastname: Bahm
mesh_terms: D020516:Brachial Plexus Neuropathies / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D018482:Muscle, Skeletal / Q000294:innervation* / Q000502:physiology; D016067:Nerve Transfer / Q000379:methods*; D010246:Paralysis, Obstetric / Q000175:diagnosis / Q000601:surgery*; D020127:Recovery of Function; D018570:Risk Assessment; D012494:Sampling Studies; D016896:Treatment Outcome; D014459:Ulnar Nerve / Q000637:transplantation*