A comparison of intercostal and partial ulnar nerve transfers in restoring elbow flexion following upper brachial plexus injury (C5-C6+/-C7).
OBJECTIVE
Restoring active elbow flexion is essential in the surgical management of C5-C6 +/- C7 brachial plexus palsies. This study compares the clinical results of 2 techniques to restore elbow flexion: the partial ulnar nerve transfer and the intercostal nerve transfer.


METHODS
Partial ulnar nerve transfer was performed in 23 patients, and intercostal nerve transfer was performed in 17 patients. For both techniques, the transfer to the musculocutaneous nerve was made at the same anatomical point. Age and preoperative delay were comparable between groups of patients.


RESULTS
Biceps reinnervation time was significantly earlier (p = .001) in the ulnar nerve technique (mean, 5.1 mo) than the intercostal nerve technique (mean 9.9 mo). Ten of 17 patients recovered useful elbow flexion force (British Medical Research Council grade >M3) in the intercostal nerve transfer group, compared with 20 of 23 patients in the ulnar nerve transfer group. No patient who had surgery more than 6 months after the injury recovered useful elbow flexion force in the intercostal nerve transfer. Elbow flexion strength was better in patients less than 30 years old in the intercostal nerve group. No complications were observed in either group.


CONCLUSIONS
This study shows that transferring fascicles of the ulnar nerve yields better results than intercostals nerve transfer for restoring elbow flexion. Moreover, preoperative delay and age are important preoperative prognostic factors for the intercostal nerves transfers.


METHODS
Therapeutic III.
Coulet
Bertrand
B
Hand and Upper Limb Surgery Department, Lapeyronie University Hospital, Montpellier, France. bertrand-coulet@wanadoo.fr
Boretto
Jorge G
JG
Lazerges
Cyril
C
Chammas
Michel
M
D000293:Adolescent; D000328:Adult; D020516:Brachial Plexus Neuropathies / Q000503:physiopathology / Q000601:surgery*; D004551:Elbow Joint / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007367:Intercostal Nerves / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016067:Nerve Transfer / Q000379:methods*; D016059:Range of Motion, Articular; D016896:Treatment Outcome; D014459:Ulnar Nerve / Q000601:surgery*; D055815:Young Adult