scholarly journals Management of Masada type I/IIb forearm deformity by gradual ulnar lengthening in patients with hereditary multiple osteochondromas

2020 ◽  
Author(s):  
Yuchan Li ◽  
Zhigang Wang ◽  
Mu Chen ◽  
Haoqi Cai
Keyword(s):  
Treatment Protocol ◽  
Elbow Flexion ◽  
Individual Treatment ◽  
Type I ◽  
Daily Life Activities ◽  
Multiple Osteochondromas ◽  
The Mean ◽  
Carrying Angle ◽  
Ulnar Lengthening

Abstract Background Gradual ulnar lengthening is the most commonly used procedure in treatment of Masada type I/II deformity in patients with hereditary multiple osteochondromas. However, the treatment remains controversial for the recurrence of deformity in growing children and only slightly handicapped of daily life activities in untreated adult patients. The aim of this study was to evaluate mid-term clinical and radiological outcomes of ulnar gradual lengthening in our clinic. Methods We retrospectively reviewed patients who underwent ulnar lengthening by distraction osteogenesis from June 2008 to October 2017. Patients with less than two years of follow-up were excluded. The surgical procedures consisted of ulnar lengthening by external fixator and/or excision of the osteochondroma at the distal ulna. The carrying angle (CA) and range of motion (ROM) of the forearm and elbow were clinically assessed, and the radial articular angle (RAA) and ulnar shortening (US) were radiologically assessed before lengthening, two months after external frame removal, and at the last follow-up. Results The current study included 15 patients (17 forearms) with a mean age of 9.4 ± 2.3 years at index surgery. The mean follow-up period was 4.2 ± 2.4 years. There were 9 patients (10 forearms) with Masada type I deformity and 6 patients (7 forearms) with Masada type IIb deformity. The mean amount of ulnar lengthening was 4.2 ± 1.2 cm. The mean RAA improved from 37.3 ± 7.9° to 29.8 ± 6.5° initially (P = 0.003) and relapsed to 34.4 ± 7.6° at the last follow-up (p = 0.234). There was minimal deterioration of US yet significant improvement at the last follow-up compared to pre-op (p < 0.001). The elbow flexion and forearm pronation were improved significantly at last follow-up (p < 0.001 and p = 0.024, respectively). The mean carrying angle improved significantly from − 6.3 ± 7.4 ° preoperatively to 7.4 ± 11.1° at last follow-up (p < 0.001). Conclusions Gradual ulnar lengthening significantly reduces cosmetic deformity and improves function; it is recommended for patients with Masada type I/IIb deformity. Therefore, we advocated aggressive individual treatment protocol for patients with Masada type I/IIb deformities.

scholarly journals Gradual ulnar lengthening in Masada type I/IIb deformity in patients with hereditary multiple osteochondromas: a retrospective study with a mean follow-up of 4.2 years

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Yuchan Li ◽  
Zhigang Wang ◽  
Mu Chen ◽  
Haoqi Cai
Keyword(s):  
Retrospective Study ◽  
Radial Head ◽  
Elbow Flexion ◽  
Type I ◽  
Multiple Osteochondromas ◽  
External Frame ◽  
The Mean ◽  
Carrying Angle ◽  
Ulnar Lengthening

Abstract Background Gradual ulnar lengthening is the most commonly used procedure in the treatment of Masada type I/II deformity in patients with hereditary multiple osteochondromas. However, the treatment remains controversial for the recurrence of deformity in growing children. This study aims to evaluate the clinical and radiological outcomes of ulnar gradual lengthening in our clinic. Methods We retrospectively reviewed patients who underwent ulnar lengthening by distraction osteogenesis from June 2008 to October 2017. The carrying angle (CA) and range of motion (ROM) of the forearm and elbow were clinically assessed, and the radial articular angle (RAA) and ulnar shortening (US) were radiologically assessed before lengthening, 2 months after external frame removal, and at the last follow-up. Results The current study included 15 patients (17 forearms) with a mean age of 9.4 ± 2.3 years at the index surgery. The mean follow-up period was 4.2 ± 2.4 years. There were 9 patients (10 forearms) with Masada type I deformity and 6 patients (7 forearms) with Masada type IIb deformity. The mean amount of ulnar lengthening was 4.2 ± 1.2 cm. The mean RAA improved from 37 ± 8 to 30 ± 7° initially (p = 0.005) and relapsed to 34 ± 8° at the last follow-up (p = 0.255). There was a minimal deterioration of US yet significant improvement at the last follow-up compared to pre-op (p < 0.001). At the last follow-up, the mean forearm pronation and elbow flexion increased significantly (p < 0.001 and p = 0.013, respectively), and the mean carrying angle also improved significantly (p < 0.001). No patient with type IIb deformity achieved a concentric radial head reduction. Conclusions Gradual ulnar lengthening significantly reduces cosmetic deformity and improves function in patients with Masada type I/IIb deformity. Our results supported early ulnar lengthening for patients with a tendency of dislocation of the radial head.

scholarly journals Ulrasonography guided Closed Reduction in the Treatment of Displaced Transphyseal Fracture of the Distal Humerus

2020 ◽  
Author(s):  
Hai Zhou ◽  
Ge Zhang ◽  
Ming Li ◽  
Xiangyang Qu ◽  
Yujiang Cao ◽  
...  
Keyword(s):  
Closed Reduction ◽  
Elbow Flexion ◽  
Distal Humerus ◽  
Cubitus Varus ◽  
Radiographic Outcomes ◽  
Male Patients ◽  
The Mean ◽  
Carrying Angle ◽  
Low Incidence

Abstract Background: To evaluate the clinical and radiographic outcomes after ulrasonography guided Closed reduction in the treatment of displaced transphyseal fracture of the distal Humerus (TFDH).Methods: Twenty-seven patients with displaced TFDH successfully treated by the ulrasonography guided closed reduction during January 2012 to December 2016 were retrospective reviewed. After mean follow-up of 34.88 months, the clinical and radiographic outcomes of patients were evaluated. The cubitus varus of the affected elbow were also assessed at latest follow-up.Results: The successful rate of ultrasonography guided closed reduction in the treatment of displaced TFDH was 84% (27/32). The twenty-seven patients with successful reduction were included for the following analysis. There were 20 male patients and 7 female patients included the study and the mean age at treatment was 15.39±3.10 months, seventeen fractures occurred in right side elbow and ten in left side. At the last follow-up, there were significant decreases in the elbow flexion (3°, P=0.027) and range of motion (5°, P=0.003) between the injured and uninjured elbow, respectively. Whereas no difference in elbow extension was detected (P=0.110). Flynn’s criteria assessment showed that all the patients achieved excellent or good outcomes both in the functional and cosmetic categories. The clinical and radiographic carrying angle at the last follow-up were 11.67 ± 3.11° and 10.46 ± 3.88°, respectively. And the incidence of cubitus varus after treament was 7.4% at last follow-up.Conclusion: The ultrasonography guided closed reduction in the treatment of displaced TFDH is an effective procedure, the adequate fracture reduction can be acquired with the advantages of real-time, non-radioactive, and simple utilization. With the percutaneous pining fixation, satisfactory clinical and radiographic outcomes can be achieved with low incidence of postoperative cubitus varus.

Analysis of human acellular nerve allograft combined with contralateral C7 nerve root transfer for restoration of shoulder abduction and elbow flexion in brachial plexus injury: a mean 4-year follow-up

2020 ◽  
Vol 132 (6) ◽  
pp. 1914-1924 ◽  
Author(s):  
Liang Li ◽  
Jiantao Yang ◽  
Bengang Qin ◽  
Honggang Wang ◽  
Yi Yang ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Nerve Root ◽  
Functional Outcomes ◽  
Elbow Flexion ◽  
Shoulder Abduction ◽  
Allograft Reconstruction ◽  
Acellular Nerve Allograft ◽  
The Mean ◽  
Monofilament Test

OBJECTIVEHuman acellular nerve allograft applications have increased in clinical practice, but no studies have quantified their influence on reconstruction outcomes for high-level, greater, and mixed nerves, especially the brachial plexus. The authors investigated the functional outcomes of human acellular nerve allograft reconstruction for nerve gaps in patients with brachial plexus injury (BPI) undergoing contralateral C7 (CC7) nerve root transfer to innervate the upper trunk, and they determined the independent predictors of recovery in shoulder abduction and elbow flexion.METHODSForty-five patients with partial or total BPI were eligible for this retrospective study after CC7 nerve root transfer to the upper trunk using human acellular nerve allografts. Deltoid and biceps muscle strength, degree of shoulder abduction and elbow flexion, Semmes-Weinstein monofilament test, and static two-point discrimination (S2PD) were examined according to the modified British Medical Research Council (mBMRC) scoring system, and disabilities of the arm, shoulder, and hand (DASH) were scored to establish the function of the affected upper limb. Meaningful recovery was defined as grades of M3–M5 or S3–S4 based on the scoring system. Subgroup analysis and univariate and multivariate logistic regression analyses were conducted to identify predictors of human acellular nerve allograft reconstruction.RESULTSThe mean follow-up duration and the mean human acellular nerve allograft length were 48.1 ± 10.1 months and 30.9 ± 5.9 mm, respectively. Deltoid and biceps muscle strength was grade M4 or M3 in 71.1% and 60.0% of patients. Patients in the following groups achieved a higher rate of meaningful recovery in deltoid and biceps strength, as well as lower DASH scores (p < 0.01): age < 20 years and age 20–29 years; allograft lengths ≤ 30 mm; and patients in whom the interval between injury and surgery was < 90 days. The meaningful sensory recovery rate was approximately 70% in the Semmes-Weinstein monofilament test and S2PD. According to univariate and multivariate logistic regression analyses, age, interval between injury and surgery, and allograft length significantly influenced functional outcomes.CONCLUSIONSHuman acellular nerve allografts offered safe reconstruction for 20- to 50-mm nerve gaps in procedures for CC7 nerve root transfer to repair the upper trunk after BPI. The group in which allograft lengths were ≤ 30 mm achieved better functional outcome than others, and the recommended length of allograft in this procedure was less than 30 mm. Age, interval between injury and surgery, and allograft length were independent predictors of functional outcomes after human acellular nerve allograft reconstruction.

Radiological and clinical associations with scoliosis outcomes after posterior fossa decompression in patients with Chiari malformation and syrinx from the Park-Reeves Syringomyelia Research Consortium

2020 ◽  
Vol 26 (1) ◽  
pp. 53-59 ◽  
Author(s):  
Jennifer M. Strahle ◽  
Rukayat Taiwo ◽  
Christine Averill ◽  
James Torner ◽  
Jordan I. Gewirtz ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Chiari Malformation ◽  
Craniocervical Junction ◽  
Curve Progression ◽  
Posterior Fossa Decompression ◽  
Type I ◽  
Younger Age ◽  
Curve Magnitude ◽  
The Mean

OBJECTIVEIn patients with Chiari malformation type I (CM-I) and a syrinx who also have scoliosis, clinical and radiological predictors of curve regression after posterior fossa decompression are not well known. Prior reports indicate that age younger than 10 years and a curve magnitude < 35° are favorable predictors of curve regression following surgery. The aim of this study was to determine baseline radiological factors, including craniocervical junction alignment, that might predict curve stability or improvement after posterior fossa decompression.METHODSA large multicenter retrospective and prospective registry of pediatric patients with CM-I (tonsils ≥ 5 mm below the foramen magnum) and a syrinx (≥ 3 mm in width) was reviewed for clinical and radiological characteristics of CM-I, syrinx, and scoliosis (coronal curve ≥ 10°) in patients who underwent posterior fossa decompression and who also had follow-up imaging.RESULTSOf 825 patients with CM-I and a syrinx, 251 (30.4%) were noted to have scoliosis present at the time of diagnosis. Forty-one (16.3%) of these patients underwent posterior fossa decompression and had follow-up imaging to assess for scoliosis. Twenty-three patients (56%) were female, the mean age at time of CM-I decompression was 10.0 years, and the mean follow-up duration was 1.3 years. Nine patients (22%) had stable curves, 16 (39%) showed improvement (> 5°), and 16 (39%) displayed curve progression (> 5°) during the follow-up period. Younger age at the time of decompression was associated with improvement in curve magnitude; for those with curves of ≤ 35°, 17% of patients younger than 10 years of age had curve progression compared with 64% of those 10 years of age or older (p = 0.008). There was no difference by age for those with curves > 35°. Tonsil position, baseline syrinx dimensions, and change in syrinx size were not associated with the change in curve magnitude. There was no difference in progression after surgery in patients who were also treated with a brace compared to those who were not treated with a brace for scoliosis.CONCLUSIONSIn this cohort of patients with CM-I, a syrinx, and scoliosis, younger age at the time of decompression was associated with improvement in curve magnitude following surgery, especially in patients younger than 10 years of age with curves of ≤ 35°. Baseline tonsil position, syrinx dimensions, frontooccipital horn ratio, and craniocervical junction morphology were not associated with changes in curve magnitude after surgery.

scholarly journals 63 Chronic Femoral Osteomyelitis Case Series: Outcomes and Economic Impact at A United Kingdom Based Tertiary Centre

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
E Lau ◽  
Z Arshad ◽  
A Aslam ◽  
A Thahir ◽  
M Krkovic
Keyword(s):  
Economic Impact ◽  
Treatment Protocol ◽  
Case Series ◽  
Consecutive Series ◽  
Financial Loss ◽  
Patient Demographics ◽  
Tertiary Centre ◽  
The Mean ◽  
Eq Vas

Abstract Introduction Osteomyelitis refers to an inflammatory process affecting bone and bone marrow. This study reviews chronic femoral osteomyelitis treatment and outcomes, including economic impact. Method We retrospectively collected data from a consecutive series of 14 chronic femoral osteomyelitis patients treated between January 2013 and January 2020. Data collected include patient demographics, comorbidities, pathogens, complications, treatment protocol and costs. Functional outcome was assessed using EuroQOL five-dimensional interview administration questionnaire (EQ-5D-5L™) and EuroQOL Visual Analogue Scale (EQ-VAS™). Results Of these, 92.9% had one or more osteomyelitis risk factor, including smoking and diabetes. Samples from 78.6% grew at least one pathogen. Only 42.9% achieved remission after initial treatment, but 85.7% were in remission at final follow-up, with no signs of recurrence throughout the follow-up period (mean: 21.4 months). The average treatment cost was £39,249.50 with a net mean loss of £19,080.10 when funding was considered. The mean-derived EQ-5D score was 0.360 and the mean EQ-VAS score was 61.7, lower than their values for United Kingdom’s general population, p = 0.0018 and p = 0.013 respectively. Conclusions Chronic femoral osteomyelitis treatment is difficult, resulting in significant economic burden. With previous studies showing cheaper osteomyelitis treatment at specialist centres, our net financial loss incurred suggests the need for management at specialised centres.

scholarly journals Minimal Invasive Surgery for Gastroesophageal Reflux Disease and Hiatus Hernia—Our Experience: A Case Series with Review of Literature

2021 ◽  
Author(s):  
Rafique Umer Harvitkar ◽  
Abhijit Joshi
Keyword(s):  
Retrospective Study ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Operating Time ◽  
Type I ◽  
Type Ii ◽  
The Mean ◽  
Gerd Symptoms

Abstract Introduction Laparoscopic fundoplication (LF) has almost completely replaced the open procedure performed for gastroesophageal reflux disease (GERD) and hiatus hernia (HH). Several studies have suggested that long-term results with surgery for GERD are better than a medical line of management. In this retrospective study, we outline our experience with LF over 10 years. Also, we analyze the factors that would help us in better patient selection, thereby positively affecting the outcomes of surgery. Patients and Methods In this retrospective study, we identified 27 patients (14 females and 13 males) operated upon by a single surgeon from 2010 to 2020 at our institution. Out of these, 25 patients (12 females and 13 males) had GERD with type I HH and 2 (both females) had type II HH without GERD. The age range was 24 to 75 years. All patients had undergone oesophago-gastro-duodenoscopy (OGD scopy). A total of 25 patients had various degrees of esophagitis. Two patients had no esophagitis. These patients were analyzed for age, sex, symptoms, preoperative evaluation, exact procedure performed (Nissen’s vs. Toupet’s vs. cruroplasty + gastropexy), morbidity/mortality, and functional outcomes. They were also reviewed to examine the length of stay, length of procedure, complications, and recurrent symptoms on follow-up. Symptoms were assessed objectively with a score for six classical GERD symptoms preoperatively and on follow-up at 1-, 4- and 6-weeks postsurgery. Further evaluation was performed after 6 months and then annually for 2 years. Results 14 females (53%) and 13 males (48%) with a diagnosis of GERD (with type I HH) and type II HH were operated upon. The mean age was 46 years (24–75 years) and the mean body mass index (BMI) was 27 (18–32). The range of duration of the preoperative symptoms was 6 months to 2 years. The average operating time dropped from 130 minutes for the first 12 cases to 90 minutes for the last 15 cases. The mean hospital stay was 3 days (range: 2–4 days). In the immediate postoperative period, 72% (n = 18) of the patients reported improvement in the GERD symptoms, while 2 (8%) patients described heartburn (grade I, mild, daily) and 1 (4%) patient described bloating (grade I, daily). A total of 5 patients (20%) reported mild dysphagia to solids in the first 2 postoperative weeks. These symptoms settled down after 2 to 5 weeks of postoperative proton-pump inhibitor (PPI) therapy and by adjusting consistency of oral feeds. There was no conversion to open, and we observed no perioperative mortality. There were no patients who underwent redo surgeries in the series. Conclusion LF is a safe and highly effective procedure for a patient with symptoms of GERD, and it gives long-term relief from the symptoms. Stringent selection criteria are necessary to optimize the results of surgery. Experience is associated with a significant reduction of operating time.

Anterior Palatoplasty for the Treatment of OSA

2009 ◽  
Vol 141 (2) ◽  
pp. 253-256 ◽  
Author(s):  
Kenny P. Pang ◽  
Raymond Tan ◽  
Puravi Puraviappan ◽  
David J. Terris
Keyword(s):  
Body Mass Index ◽  
Clinical Stage ◽  
Long Term Results ◽  
Apnea Hypopnea Index ◽  
Type I ◽  
Obstructive Sleep ◽  
The Mean ◽  
Anterior Palatoplasty

OBJECTIVE: Review long-term results of the modified cautery-assisted palatoplasty (mod CAPSO)/anterior palatoplasty for the treatment of mild-moderate obstructive sleep apnea (OSA). STUDY DESIGN: Prospective series of 77 patients. All patients were >18 years old, type I Fujita, body mass index (BMI) < 33, Friedman clinical stage II, with apnea-hypopnea index (AHI) from 1.0 to 30.0. The mean follow-up time was 33.5 months. The procedure involved an anterior soft palatal advancement technique with or without removal of the tonsils. The procedure was done under general or local anesthesia. RESULTS: There were 69 men and eight women; the mean age was 39.3 years old; and mean BMI was 24.9 (range 20.7–26.8). There were 38 snorers and 39 OSA patients. The AHI improved in patients with OSA, 25.3 ± 12.6 to 11.0 ± 9.9 ( P < 0.05). The overall success rate for this OSA group was 71.8 percent (at mean 33.5 months). The mean snore scores (visual analog score) improved from 8.4 to 2.5 (for all 77 patients). Lowest oxygen saturation also improved in all OSA patients. Subjectively, all patients felt less tired. CONCLUSION: This technique has been shown to be effective in the management of patients with snoring and mild-moderate OSA.

scholarly journals Early experience with a novel net temporary bridging device (Cascade) to assist endovascular coil embolization of intracranial aneurysms

2020 ◽  
pp. 1-9
Author(s):  
Alejandro Tomasello ◽  
David Hernandez ◽  
Laura Ludovica Gramegna ◽  
Sonia Aixut ◽  
Roger Barranco Pons ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Type I ◽  
Type Ii ◽  
Unruptured Aneurysms ◽  
Complete Obliteration ◽  
Acute Subarachnoid Hemorrhage ◽  
Endovascular Coil Embolization ◽  
The Mean

OBJECTIVEThe goal of this study was to evaluate the effectiveness and safety of a new noncompletely occlusive net-assisted remodeling technique in which the Cascade net device is used for temporary bridging of intracranial aneurysms.METHODSBetween July 2018 and May 2019, patients underwent coil embolization with the Cascade net device within 4 centers in Europe. Analysis of angiographic (modified Raymond-Roy classification [MRRC]) and clinical outcomes data was conducted immediately following treatment and at the 6-month follow-up.RESULTSFifteen patients were included in the study (mean age 58 ± 13 years, 11/15 [73.3%] female). Ten patients had unruptured aneurysms, and 5 presented with ruptured aneurysms with acute subarachnoid hemorrhage. The mean aneurysm dome length was 6.27 ± 2.33 mm and the mean neck width was 3.64 ± 1.19 mm. Immediately postprocedure, MRRC type I (complete obliteration) was achieved in 11 patients (73.3%), whereas a type II (residual neck) was achieved in 4 patients (26.7%). Follow-up examination was performed in 7/15 patients and showed stabilization of aneurysm closure with no thromboembolic complications and only 1 patient with an increased MRRC score (from I to II) due to coil compression.CONCLUSIONSInitial experience shows that the use of a new noncompletely occlusive net-assisted remodeling technique with the Cascade net device may be safe and effective for endovascular coil embolization of intracranial aneurysms.

scholarly journals Influence of Ulnar Bow Sign on Surgical Treatment of Missed Bado Type I Monteggia Fracture in Children

2020 ◽  
Author(s):  
Shijie Liao ◽  
Tiantian Wang ◽  
Qian Huang ◽  
Yun Liu ◽  
Rongbin Lu ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Radial Head ◽  
Monteggia Fracture ◽  
Type I ◽  
Ulnar Osteotomy ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Stable Reduction

Abstract PurposeThe present study aimed to explore the influence of ulnar bow on the surgical treatment of Bado type I missed Monteggia fracture in children.MethodsThis study is a retrospective review of 24 patients between November 2010 and March 2019. All patients were treated with open reduction of the radial head and ulnar opening wedge osteotomy without annular ligament reconstruction. The mean interval between injury onset and surgery was five months (range: 2–12 months). The average age of participants at the time of surgery was 6.4 years (range: 3–10 years). We evaluated the maximum ulnar bow (MUB) and MUB position (P-MUB) via radiography. The patients were divided into middle group (group A: 14 cases, MUB located at 40% to 60% of the distal ulna) and distal group (group B: 10 cases, MUB located at 20% to 40% from the distal end of the ulna) based on P-MUB. The mean period of follow-up was 37 months (range: 6–102 months).ResultsAt the last follow-up, all the children showed stable reduction of the radial head, and the flexion function of elbow joint improved after operation (P<0.05). Group A presented a larger the ratio of maximum ulnar bow(R-MUB) and angle of ulnar osteotomy(OA) than group B (P<0.05). There was statistically significant difference between group A and Group B in the P-MUB (P < 0.05). The osteotomy angle was positively correlated with the R-MUB (R2 =0.497,P=0.013), The osteotomy angle was positively correlated with the P-MUB (R2=0.731,P=0.000), The R-MUB is proportional to the P-MUB (R2 =0.597,P=0.002). The regression equation of P-MUB and osteotomy angle: Angle=7.064+33.227* P-MUB (R2=0.459, P =0.000).ConclusionWhen the ulnar bow is positioned at the middle ulna, a stable reduction of radial head need to be achieved through a larger angle in the ulnar osteotomy. If the position of maximum ulnar bow (P-MUB) is closer to the middle of the ulna or the ratio of maximum ulnar bow (R-MUB) is larger, the osteotomy angle is larger.

Minimum Ten-Year Outcomes of Partial Ulnar Nerve Transfer for Restoration of Elbow Flexion in Patients with Upper Brachial Plexus Injury

2019 ◽  
Vol 24 (03) ◽  
pp. 283-288
Author(s):  
Yusuke Nagano ◽  
Daisuke Kawamura ◽  
Alaa Terkawi ◽  
Atsushi Urita ◽  
Yuichiro Matsui ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Functional Outcomes ◽  
Brachial Plexus Injury ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
The Mean ◽  
Flexion Strength

Background: Partial ulnar nerve transfer to the biceps motor branch of the musculocutaneous nerve (Oberlin’s transfer) is a successful approach to restore elbow flexion in patients with upper brachial plexus injury (BPI). However, there is no report on more than 10 years subjective and objective outcomes. The purpose of this study was to clarify the long-term outcomes of Oberlin’s transfer based on the objective evaluation of elbow flexion strength and subjective functional evaluation of patients. Methods: Six patients with BPI who underwent Oberlin’s transfer were reviewed retrospectively by their medical records. The mean age at surgery was 29.5 years, and the mean follow-up duration was 13 years. The objective functional outcomes were evaluated by biceps muscle strength using the Medical Research Council (MRC) grade at preoperative, postoperative, and final follow-up. The patient-derived subjective functional outcomes were evaluated using the Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) questionnaire at final follow-up. Results: All patients had MRC grade 0 (M0) or 1 (M1) elbow flexion strength before operation. Four patients gained M4 postoperatively and maintained or increased muscle strength at the final follow-up. One patient gained M3 postoperatively and at the final follow-up. Although one patient achieved M4 postoperatively, the strength was reduced to M2 due to additional disorder. The mean score of QuickDASH was 36.5 (range, 7–71). Patients were divided into two groups; three patients had lower scores and the other three patients had higher scores of QuickDASH. Conclusions: Oberlin’s transfer is effective in the restoration of elbow flexion and can maintain the strength for more than 10 years. Patients with upper BPI with restored elbow flexion strength and no complicated nerve disorders have over ten-year subjective satisfaction.

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