The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

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

Document Type : RESEARCH PAPER

Authors
Reza Shahriar Kamrani 1
Mohammadreza Hozhabrbayan 1
Kasra Mirzaei 1
Hesam Alitaleshi 2
Dorsa Ghorban Sarvi 3
Shervin Mossavarali 1
1 Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran
2 Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran - Center for Orthopedic Trans-Disciplinary Applied Research, 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 the transfer of fascicles from the ulnar and median nerves to the biceps and brachialis muscles. In contrast, 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 in the study 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 the range of motion in the elbow and shoulder joints, hand grip strength, elbow flexion strength, elbow flexion velocity, and brachioradialis muscle bulk.
Results: All patients achieved an MRC grade of 4 for elbow flexion strength. Brachioradialis muscle bulk was recovered in the Oberlin III group, which also demonstrated a higher elbow flexion velocity (P = 0.032). Additionally, higher mean values were observed in the Oberlin III group for elbow flexion strength (in both supination and pronation) and QuickDASH scores. However, no statistically significant differences were found for these outcomes.
Conclusion: The Oberlin III technique was associated with the recovery of brachioradialis muscle bulk and improved elbow flexion velocity. These preliminary findings suggest potential functional benefits, highlighting the need for further investigation in larger cohorts.
        Level of evidence: III
Keywords
Brachial plexus injury
C5-C6 avulsion
Elbow flexion
Nerve transfer
Oberlin procedure
Subjects
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The Archives of Bone and Joint Surgery
Volume 14, Issue 3
March 2026
Pages 179-184

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