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Modified Oberlin double fascicular nerve transfer for elbow flexion: FCR fascicle to motor branch to biceps and FCU fascicle to motor branch to brachialis surgical technique

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Learn the Modified Oberlin double fascicular nerve transfer for elbow flexion: FCR fascicle to motor branch to biceps and FCU fascicle to motor branch to brachialis surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Modified Oberlin double fascicular nerve transfer for elbow flexion: FCR fascicle to motor branch to biceps and FCU fascicle to motor branch to brachialis surgical procedure.

Christophe Oberlin popularised the technique of nerve transfer for restoration of elbow flexion after upper brachial plexus palsy. The original technique involved highly selective fascicle transfer of a predominant flexor carpi ulnaris fascicle from the ulnar nerve to the motor branch to biceps. The technique enabled reliable and rapid re-innervation of biceps and superior results to nerve grafting for upper trunk ruptures. Modifications have included a double transfer technique using fascicles from both median and ulnar nerves transferred to the motor branches to biceps and to brachialis. I use a double technique in cases of complete elbow flexion paralysis with loss of biceps, brachialis and brachioradialis such as that resulting from a C5/6 avulsion injury or delayed presentation following rupture of the upper trunk.  In cases of isolated musculocutaneous injury, proximal reconstruction for biceps can be combined with a single distal transfer to the brachialis from the ulnar nerve. The technique can also be used to salvage late presenting upper trunk or lateral cord ruptures where the time-distance phenomenon dictates that late nerve graft of a proximal rupture is unlikely to be successful or cases where proximal reconstruction has failed to provide functional elbow flexion by 9 months following injury.

Author: Dominic Power FRCS Orth, Consultant Hand and Peripheral Nerve Surgeon

Institution: Peripheral Nerve Injury Service, Birmingham Hand Centre, Queen Elizabeth Hospital, UK

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