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

Document Type : RESEARCH PAPER

Authors

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

Main Subjects

References

  1. Verdins K, Kapickis M. Oberlin's Transfer: Long Term Outcomes. J Hand Surg Asian Pac Vol. 2018;23(2):176-180. doi:10.1142/s2424835518500170.
  2. Songcharoen P, Wongtrakul S, Spinner RJ. Brachial plexus injuries in the adult. Nerve transfers: the Siriraj Hospital experience. Hand Clin. 2005;21(1):83-9. doi:10.1016/j.hcl.2004.10.002.
  3. Oberlin C, Béal D, Leechavengvongs S, Salon A, Dauge MC, Sarcy JJ. Nerve transfer to biceps muscle using a part of the ulnar nerve for C5-C6 avulsion of the brachial plexus: anatomical study and report of four cases. J Hand Surg Am. 1994;19(2):232-7. doi:10.1016/0363-5023(94)90011-6.
  4. Mackinnon SE, Novak CB, Myckatyn TM, Tung TH. Results of reinnervation of the biceps and brachialis muscles with a double fascicular transfer for elbow flexion. J Hand Surg Am. 2005;30(5):978-85. doi:10.1016/j.jhsa.2005.05.014.
  5. Tung TH, Novak CB, Mackinnon SE. Nerve transfers to the biceps and brachialis branches to improve elbow flexion strength after brachial plexus injuries. J Neurosurg. 2003;98(2):313-8. doi:10.3171/jns.2003.98.2.0313.
  6. Donnelly MR, Rezzadeh KT, Vieira D, Daar D, Hacquebord J. Is one nerve transfer enough? A systematic review and pooled analysis comparing ulnar fascicular nerve transfer and double ulnar and median fascicular nerve transfer for restoration of elbow flexion after traumatic brachial plexus injury. Microsurgery. 2020;40(3):361-369. doi:10.1002/micr.30536.
  7. Kokkalis ZT, Bavelou A, Papanikos E, Konofaos P, Efstathopoulos DG, Soucacos PN. Reconstruction of elbow flexion with a modified Oberlin procedure: A comparative study. Injury. 2019;50:S71-S76. doi: 10.1016/j.injury.2019.10.053.
  8. Carlsen BT, Kircher MF, Spinner RJ, Bishop AT, Shin AY. Comparison of single versus double nerve transfers for elbow flexion after brachial plexus injury. Plast Reconstr Surg. 2011;127(1):269-276. doi:10.1097/PRS.0b013e3181f95be7.
  9. Martins RS, Siqueira MG, Heise CO, Foroni L, Teixeira MJ. A prospective study comparing single and double fascicular transfer to restore elbow flexion after brachial plexus injury. Neurosurgery. 2013;72(5):709-14; discussion 714-5; quiz 715. doi:10.1227/NEU.0b013e318285c3f6.
  10. Boland MR, Spigelman T, Uhl TL. The function of brachioradialis. J Hand Surg Am. 2008;33(10):1853-9. doi:10.1016/j.jhsa.2008.07.019.
  11. Caufriez B, Dugailly PM, Brassinne E, Schuind F. The Role of the Muscle Brachioradialis in Elbow Flexion: An Electromyographic Study. J Hand Surg Asian Pac Vol. 2018;23(1):102-110. doi:10.1142/s2424835518500145.
  12. Kamrani RS, Mirzaei K, Hozhabrbayan M, Alitaleshi H, Mossavarali S. Triple nerve transfer for restoration of elbow flexion in C5–C6 traumatic brachial plexus injuries. J Hand Surg Eur Vol. 2025:17531934241307529. doi: 10.1177/17531934241307529.

 

 

 

 

The Archives of Bone and Joint Surgery
Volume 14, Issue 3
March 2026
Pages 179-184

Files

History

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

Share

How to cite

Statistics