title: Restoration of elbow and hand function in total brachial plexus palsy with intercostal nerves and C5 root neurotization. Results in 21 patients.
abstract: Consensus opinion is that active movement of the elbow is a priority in the surgical treatment of total brachial plexus injuries. But the indications and neurotization techniques used to restore motor function of the hand are the subject of discussion. The aim of this retrospective study was to evaluate, in adult patients with complete post-traumatic paralysis of the brachial plexus, the functional results of neurotization of four intercostal nerves on the musculocutaneous nerve and grafting of the C5 root by one strand on the nerve to the long head of triceps and three strands on the medial component of the median nerve. The cohort included 21 patients (mean age 21years). The average time between the trauma and surgical treatment was 4.8months. At a mean follow-up of 22months, 67% of patients achieved≥M3 elbow flexion, and 62% achieved≥M3 active elbow extension. Of the patients who had the required follow-up of 2years to assess motor recovery of the median nerve, 40% achieved function≥M3. Based on our results, use of the C5 root is suitable for surgically restoring elbow extension and finger flexion.
authors: Service de chirurgie orthopédique et traumatologique, CHU Edouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France. Electronic address: maximilien.arnal@yahoo.fr.
authors: M
authors: M
authors: Arnal
authors: Service de chirurgie orthopédique et traumatologique, CHU Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France. Electronic address: adeline_cambon@yahoo.fr.
authors: A
authors: A
authors: Cambon
authors: Service de chirurgie orthopédique et traumatologique, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France. Electronic address: psmarcheix@orange.fr.
authors: P-S
authors: PS
authors: Marcheix
authors: Clinique Mont-Louis, 8, rue de la Folie-Regnault, 75011 Paris, France. Electronic address: belkheyar.zoubir@gmail.com.
authors: Z
authors: Z
authors: Belkhayar
mesh_terms: D000293:Adolescent; D000328:Adult; D020516:Brachial Plexus Neuropathies / Q000534:rehabilitation*; D004551:Elbow Joint; D005260:Female; D006225:Hand; D006801:Humans; D007367:Intercostal Nerves / Q000637:transplantation*; D008297:Male; D010243:Paralysis / Q000534:rehabilitation*; D020127:Recovery of Function; D012189:Retrospective Studies; D013126:Spinal Nerve Roots; D061665:Time-to-Treatment; D055815:Young Adult
keywords: C5 root; Coude; Elbow; Hand; Intercostal nerve; Main; Nerf intercostal; Neurotisation; Neurotization; Plexus brachial total; Racine C5; Total brachial plexus