Abstract
Introduction
In upper brachial plexus injuries (C5-C6-C7), selective nerve transfers appear as
a favourable technique. For this purpose, transfer of an ulnar nerve fascicle to the
biceps motor branch (Oberlin's procedure) is often used. In this paper we present
our modified Oberlin technique, as well as a comparison of this method with the classic
Oberlin procedure.
Materials and Methods
We present two groups of patients that where operated by two different surgeons. The
first group, consisting of 16 patients was treated with the classic Oberlin procedure.
The second group included 5 patients treated with a modified Oberlin procedure, where
two fascicles from the ulnar nerve were transferred to both the motor branch of the
biceps and the motor branch of the brachialis muscles.
Results
In the last follow-up of the 16 patients from the first group with the classic Oberlin
procedure, 15 patients (93.75%) had Medical Research Council (MRC) grade of biceps
strength 4 and 1 patient (6.25%) had MRC grade 3, whereas in the group where the modified
Oberlin procedure was used the muscle strength was very durable with 4 out of 5 the
patients reached MRC grade of 4+ and one MRC grade of 4, and with a mean elbow strength
at 5.4 kg (3–8 kg). No sensitivity or motor problems were encountered on the ulnar
territories for both groups.
Conclusion
With the modified Oberlin technique, the median nerve is reserved and both elbow flexors
are innervated. The results of this technique compare favourably with those of other
methods. Thus, we propose using the double fascicle transfer from the ulnar nerve
to both elbow flexors in order to restore a strong elbow flexion in patients with
upper brachial plexus injuries.
Keywords
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Article info
Publication history
Published online: October 21, 2019
Footnotes
☆This paper is part of a Supplement supported by the European Federation of Societies of Microsurgery (EFSM) and the Serbian Society for Reconstructive Microsurgery (SSRM).
Identification
Copyright
© 2019 Elsevier Ltd. All rights reserved.
