Quality of life in patients following distal nerve transfers for the restoration of elbow flexion and extension- single center experience.

INTRODUCTION

Peripheral nerve injuries, though relatively uncommon, predominantly affect young adults after high-energy trauma and carry significant socioeconomic impact. Brachial plexus traction injuries are particularly challenging, with uncertain outcomes after conventional grafting. Distal nerve transfers shorten regeneration distance and avoid scarred zones, providing reliable restoration of elbow function.

RESEARCH QUESTION: Can distal nerve transfers (Oberlin and thoracodorsal-to-triceps) reliably restore elbow flexion and extension and improve quality of life in patients with otherwise irreparable peripheral nerve injuries?

MATERIAL AND

METHODS

We conducted a prospective study of 31 patients with upper extremity nerve injuries treated between 2016 and 2022. All underwent distal nerve transfers: Oberlin (n = 24), modified Oberlin (n = 2), thoracodorsal-to-triceps (n = 7). Outcomes were assessed at 24 months, including elbow flexion/extension, range of motion, supination, and quality of life using the PNSQoL score.

RESULTS

Functional recovery was achieved in >95% of patients. Among Oberlin procedures, 23/24 regained M3-M5 flexion, with 4 reaching M5; supination recovery paralleled flexion. Both modified Oberlin cases achieved M4-M5 strength. All thoracodorsal-to-triceps transfers restored functional extension (6 M5, 1 M4). Overall, mean PNSQoL score improved from 27.4 preoperatively to 66.5 postoperatively. Delayed surgery correlated negatively with strength and QOL recovery.

DISCUSSION AND

CONCLUSION

Distal nerve transfers provide robust motor recovery and meaningful improvements in daily independence and social participation. The Oberlin transfer remains the benchmark for elbow flexion, while thoracodorsal-to-triceps transfer is a dependable option for extension. Early reconstruction maximizes outcomes. Future multicenter studies with standardized patient-reported outcomes are needed to further validate these findings.