Double Nerve Transfer versus Triple Nerve Transfer for Elbow Flexion Restoration in C5-C6 Traumatic Brachial Plexus Injuries

Articles in Press

Document Type : RESEARCH PAPER

Authors

1 Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran

2 Department of Orthopedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences,Tehran, Iran

3 Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran

10.22038/abjs.2025.87587.3964

Abstract

Objectives: This preliminary study compares two nerve transfer techniques for restoring elbow function in patients with C5–C6 brachial plexus injuries. The double nerve transfer (Oberlin II) involves fascicles from the ulnar and median nerves to the biceps and brachialis muscles, while the triple nerve transfer (Oberlin III) includes an additional transfer from the radial nerve to the brachioradialis muscle.

Methods: Nine patients with C5-C6 traumatic brachial plexus injuries were included and followed for five years after nerve transfer surgery. Four patients underwent the Oberlin III technique, while five received the Oberlin II procedure. Outcomes assessed included elbow and shoulder joint range of motion, hand grip strength, elbow flexion strength, elbow flexion velocity, and brachioradialis muscle bulk.

Results: All patients achieved an MRC grade of 4 in elbow flexion strength. Brachioradialis muscle bulk was recovered in the Oberlin III group. This group also showed higher elbow flexion velocity (P = 0.032). Furthermore, higher mean values were observed in the Oberlin III group for elbow flexion strength (in both supination and pronation) and QuickDASH scores; however, we did not detect statistically significant differences for these outcomes.

Conclusion: The Oberlin III technique was associated with recovery of brachioradialis muscle bulk and improved elbow flexion velocity. These preliminary findings suggest potential functional benefits, warranting further investigation in larger cohorts.

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The Archives of Bone and Joint Surgery

Articles in Press, Accepted Manuscript
Available Online from 19 October 2025

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History

  • Receive Date: 22 April 2025
  • Revise Date: 16 October 2025
  • Accept Date: 26 July 2025

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