Carlsen, Plast Reconstr Surg 2011 - Comparison of Single versus Double Nerve Transfers for Elbow Flexion after Brachial Plexus Injury

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Comparison of Single versus Double Nerve Transfers for Elbow Flexion after Brachial Plexus Injury

Carlsen, Shin, et al.·Plast Reconstr Surg·2011·108 citations·Retrospective cohort

Background

Restoration of elbow flexion is commonly achieved with nerve transfer to the musculocutaneous nerve branches after upper trunk brachial plexus injury. It is unknown if double nerve transfer to the biceps and brachialis nerve branches results in greater strength than single nerve transfer to the biceps branch alone.

Methods

A retrospective review was performed of all patients receiving nerve transfer to restore elbow flexion.
Single and double nerve transfers were compared in regard to severity of injury, elbow flexion, supination, grip strengths, and Disabilities of the Arm, Shoulder, and Hand scores.
Elbow flexion and supination torque strength were measured quantitatively.

Results

55 patients underwent nerve transfer to restore elbow flexion (23 single, 32 double).
At similar follow-up periods, British Medical Research Council grade improved to 4 or better in 14 of 21 single and 24 of 30 double nerve transfer patients.
Supination strength was similar between groups (p = 0.148).
Grip strength was greater in the double nerve transfer patients (p = 0.028).
Preoperative Disabilities of the Arm, Shoulder, and Hand scores were significantly greater in single versus double nerve transfer patients (p = 0.018).
Although single nerve transfer patients had a greater improvement in scores, the final mean scores were similar in the 2 groups.
The severity of injury was different between the 2 groups, with 19 of 23 single nerve transfer patients having injury beyond the C5-6 level and only 16 of 32 of double nerve transfer patients with greater than C5-6 injury (p = 0.020).

Conclusions

Outcomes are similar between the two groups for elbow flexion and supination strength. Postoperative Disabilities of the Arm, Shoulder, and Hand scores are similar in single and double nerve transfer patients.

Copyright remains with the authors and publisher.

Comparison of Single versus Double Nerve Transfers for Elbow Flexion after Brachial Plexus Injury

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Paprosky, Lawrence, et al.J Arthroplasty19941,213 citationsRetrospective cohort

Effects of Bracing in Adolescents with Idiopathic Scoliosis.

Weinstein, Dobbs, et al.N Engl J Med20131,160 citationsRCT

Adolescent Idiopathic Scoliosis: A New Classification to Determine Extent of Spinal Arthrodesis.

Lenke, Blanke, et al.J Bone Joint Surg Am20011,720 citationsDiagnostic study

Problems in the Management of Type III (Severe) Open Fractures: A New Classification of Type III Open Fractures.

Gustilo, Williams, et al.J Trauma19842,361 citationsRetrospective cohort

Neer Award 2005: The Grammont Reverse Shoulder Prosthesis: Results in Cuff Tear Arthritis, Fracture Sequelae, and Revision Arthroplasty.

Boileau, Hovorka, et al.J Shoulder Elbow Surg20061,115 citationsProspective cohort

A System for the Surgical Staging of Musculoskeletal Sarcoma.

Enneking, Goodman, et al.Clin Orthop Relat Res19802,112 citationsRetrospective cohort

Fracture Fixation in the Operative Management of Hip Fractures (FAITH): An International, Multicentre, Randomised Controlled Trial.

Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) InvestigatorsLancet2017310 citationsRCT

Fatty Muscle Degeneration in Cuff Ruptures. Pre- and Postoperative Evaluation by CT Scan.

Goutallier, Voisin, et al.Clin Orthop Relat Res19942,669 citationsProspective cohort

Dislocations after Total Hip-Replacement Arthroplasties.

Lewinnek, Zimmerman, et al.J Bone Joint Surg Am19782,549 citationsRetrospective cohort

Morphologic Study of the Glenoid in Primary Glenohumeral Osteoarthritis.

Walch, Khoury, et al.J Arthroplasty19991,142 citationsRetrospective cohort

The Three Column Spine and Its Significance in the Classification of Acute Thoracolumbar Spinal Injuries.

DenisSpine (Phila Pa 1976)19832,566 citationsRetrospective cohort

The Reverse Shoulder Prosthesis for Glenohumeral Arthritis Associated with Severe Rotator Cuff Deficiency. A Minimum Two-Year Follow-Up Study of Sixty Patients.

Frankle, Vasey, et al.J Bone Joint Surg Am2005773 citationsRetrospective cohort

Randomized Trial of Reamed and Unreamed Intramedullary Nailing of Tibial Shaft Fractures.

Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures Investigators, Walter, et al.J Bone Joint Surg Am2008445 citationsRCT

A New Classification of Thoracolumbar Injuries: The Importance of Injury Morphology, the Integrity of the Posterior Ligamentous Complex, and Neurologic Status.

Vaccaro, Oner, et al.Spine (Phila Pa 1976)2005866 citationsConsensus statement

A Trial of Wound Irrigation in the Initial Management of Open Fracture Wounds.

FLOW Investigators, Guyatt, et al.N Engl J Med2015347 citationsRCT

Curve Progression in Idiopathic Scoliosis.

Weinstein, PonsetiJ Bone Joint Surg Am1983641 citationsRetrospective cohort

Traumatic Glenohumeral Bone Defects and Their Relationship to Failure of Arthroscopic Bankart Repairs: Significance of the Inverted-Pear Glenoid and the Humeral Engaging Hill-Sachs Lesion.

Burkhart, De BeerArthroscopy20001,884 citationsCase series

The Value of the Tip-Apex Distance in Predicting Failure of Fixation of Peritrochanteric Fractures of the Hip.

Baumgaertner, Keggi, et al.J Bone Joint Surg Am19951,441 citationsRetrospective cohort

Transchondral Fractures (Osteochondritis Dissecans) of the Talus.

Berndt, HartyJ Bone Joint Surg Am1959945 citationsBiomechanical study

Surgical versus Nonsurgical Therapy for Lumbar Spinal Stenosis.

Weinstein, SPORT Investigators, et al.N Engl J Med20081,207 citationsRCT

The Lateral Pillar Classification of Legg-Calvé-Perthes Disease.

Herring, Browne, et al.J Pediatr Orthop1992461 citationsRetrospective cohort

Natural History of Asymptomatic Rotator Cuff Tears: A Longitudinal Analysis of Asymptomatic Tears Detected Sonographically.

Yamaguchi, Middleton, et al.J Shoulder Elbow Surg2001498 citationsRetrospective cohort

The Rotator Crescent and Rotator Cable: An Anatomic Description of the Shoulder's "Suspension Bridge".

Burkhart, Jolson, et al.Arthroscopy1993469 citationsAnatomic study

Posterolateral Rotatory Instability of the Elbow.

O'Driscoll, Morrey, et al.J Bone Joint Surg Am1991997 citationsCase series

Preoperative versus Postoperative Radiotherapy in Soft-Tissue Sarcoma of the Limbs: A Randomised Trial.

O'Sullivan, Zee, et al.Lancet20021,587 citationsRCT

Nonoperative Treatment Compared with Plate Fixation of Displaced Midshaft Clavicular Fractures. A Multicenter, Randomized Clinical Trial.

Canadian Orthopaedic Trauma SocietyJ Bone Joint Surg Am2007804 citationsRCT

Microvasculature of the Human Meniscus.

Arnoczky, WarrenAm J Sports Med19821,227 citationsAnatomic study

Metastatic Disease in Long Bones. A Proposed Scoring System for Diagnosing Impending Pathologic Fractures.

MirelsClin Orthop Relat Res19891,222 citationsRetrospective cohort

Early versus Delayed Decompression for Traumatic Cervical Spinal Cord Injury: Results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS).

Fehlings, Rampersaud, et al.PLoS One20121,200 citationsProspective cohort

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NeerClin Orthop Relat Res19831,827 citationsReview article

Direct Decompressive Surgical Resection in the Treatment of Spinal Cord Compression Caused by Metastatic Cancer: A Randomised Trial.

Patchell, Young, et al.Lancet20052,356 citationsRCT

Injuries Involving the Epiphyseal Plate

Salter, HarrisJ Bone Joint Surg Am19631,737 citationsRetrospective cohort

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Burkhart, Kibler, et al.Arthroscopy2003929 citations

Cuff-Tear Arthropathy.

Neer, Fukuda, et al.J Bone Joint Surg Am1983774 citationsCase series

A System of Staging Musculoskeletal Neoplasms.

EnnekingClin Orthop Relat Res19861,083 citationsReview article

Elbow Instability.

O'DriscollActa Orthop Belg199959 citationsReview article

Effect of Achilles Tendon Lengthening on Neuropathic Plantar Ulcers: A Randomized Clinical Trial

Mueller, Johnson, et al.J Bone Joint Surg Am2003347 citationsRCT

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HarringtonJ Bone Joint Surg Am1981303 citationsCase series

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Wasielewski, Rubash, et al.J Bone Joint Surg Am1990290 citationsAnatomic study

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Hewett, Succop, et al.Am J Sports Med20053,495 citationsProspective cohort

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Beck, Ganz, et al.J Bone Joint Surg Br20051,955 citationsRetrospective cohort

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Sanders, Walling, et al.Clin Orthop Relat Res1993891 citationsProspective cohort

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Stulberg, Wallensten, et al.J Bone Joint Surg Am1981810 citationsRetrospective cohort

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Jobe, Lombardo, et al.J Bone Joint Surg Am1986758 citationsCase series

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NeerJ Bone Joint Surg Am1974598 citationsCase series

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HawkinsJ Bone Joint Surg Am1970556 citationsRetrospective cohort

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CharnleyLancet1961834 citationsCase series

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Grood, Noyes, et al.J Bone Joint Surg Am1988674 citationsBiomechanical study

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Ponseti, SmoleyClin Orthop Relat Res1963218 citationsRetrospective cohort

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Stiell, Worthington, et al.JAMA20011,283 citationsProspective cohort

The Arterial Vascularization of the Humeral Head. An Anatomical Study.

Gerber, Vinh, et al.J Bone Joint Surg Am1990441 citationsAnatomic study

SLAP Lesions of the Shoulder.

Snyder, Friedman, et al.Arthroscopy19901,264 citationsCase series

Displaced Proximal Humeral Fractures. II. Treatment of Three-Part and Four-Part Displacement.

NeerJ Bone Joint Surg Am19701,283 citationsRetrospective cohort

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Rosenberg, Wesley, et al.Ann Surg19821,347 citationsRCT

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NeerJ Bone Joint Surg Am1972536 citationsCase series

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Boden, Wiesel, et al.J Bone Joint Surg Am1990668 citationsProspective cohort

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Griffin, FASHIoN Study Group, et al.Lancet2018542 citationsRCT

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Insall, Burstein, et al.J Bone Joint Surg Am1982470 citationsRetrospective cohort

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Dejour, Guier, et al.Knee Surg Sports Traumatol Arthrosc19941,987 citationsCase-control study

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Judet, Letournel, et al.J Bone Joint Surg Am1964980 citationsCase series

Inferior Capsular Shift for Involuntary Inferior and Multidirectional Instability of the Shoulder. A Preliminary Report.

Neer, FosterJ Bone Joint Surg Am1980934 citationsCase series

The Impact of Positive Sagittal Balance in Adult Spinal Deformity.

Glassman, Schwab, et al.Spine (Phila Pa 1976)20051,878 citationsRetrospective cohort

An Analysis of Outcomes of Reconstruction or Amputation after Leg-Threatening Injuries.

Bosse, Castillo, et al.N Engl J Med2002901 citationsProspective cohort

Normal and Abnormal Motion of the Shoulder.

Poppen, WalkerJ Bone Joint Surg Am1976886 citationsCase-control study

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Harms, MelcherSpine (Phila Pa 1976)20011,528 citationsCase series

A Randomized Trial of Vertebroplasty for Osteoporotic Spinal Fractures.

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Hoffman, Zucker, et al.N Engl J Med20001,302 citationsProspective cohort

Total Hip Arthroplasty or Hemiarthroplasty for Hip Fracture

HEALTH Investigators, Devereaux, et al.N Engl J Med2019507 citationsRCT

A Classification for Congenital Limb Malformations.

SwansonJ Hand Surg Am1976429 citationsReview article

Treatment of Grade IV Fracture-Dislocation of the Hip.

PipkinJ Bone Joint Surg Am1957445 citationsCase series

Compression-Plate Fixation in Acute Diaphyseal Fractures of the Radius and Ulna

Anderson, Park, et al.J Bone Joint Surg Am1975416 citationsCase series

Legg-Calve-Perthes Disease. Part II: Prospective Multicenter Study of the Effect of Treatment on Outcome.

Herring, Browne, et al.J Bone Joint Surg Am2004143 citationsProspective cohort

The Role of the Scapula in Athletic Shoulder Function.

KiblerAm J Sports Med19981,240 citationsReview article

The SLAC Wrist: Scapholunate Advanced Collapse Pattern of Degenerative Arthritis.

Watson, BalletJ Hand Surg Am19841,138 citationsRetrospective cohort

Classification and an Algorithmic Approach to the Reconstruction of Femoral Deficiency in Revision Total Hip Arthroplasty.

Valle, PaproskyJ Bone Joint Surg Am2003199 citationsRetrospective cohort

The Tibial Plateau Fracture. The Toronto Experience 1968--1975.

Schatzker, Bruce, et al.Clin Orthop Relat Res19791,029 citationsRetrospective cohort

Surgical Dislocation of the Adult Hip a Technique with Full Access to the Femoral Head and Acetabulum without the Risk of Avascular Necrosis.

Ganz, Berlemann, et al.J Bone Joint Surg Br20011,367 citationsCase series

Predictors of Humeral Head Ischemia after Intracapsular Fracture of the Proximal Humerus.

Hertel, Leunig, et al.J Shoulder Elbow Surg2004837 citationsProspective cohort

Early versus Delayed Stabilization of Femoral Fractures. A Prospective Randomized Study.

Bone, Scheinberg, et al.J Bone Joint Surg Am1989795 citationsRCT

Acetabulum Fractures: Classification and Management.

LetournelClin Orthop Relat Res1980715 citationsRetrospective cohort

A Novel Classification System for Spinal Instability in Neoplastic Disease: An Evidence-Based Approach and Expert Consensus from the Spine Oncology Study Group.

Fisher, Fourney, et al.Spine (Phila Pa 1976)20101,224 citationsConsensus statement

Surgical vs. Nonsurgical Treatment of Adults with Displaced Fractures of the Proximal Humerus: The PROFHER Randomized Clinical Trial.

Rangan, PROFHER Trial Collaborators, et al.JAMA2015540 citationsRCT

Lumbar Disc Herniation. A Controlled, Prospective Study with Ten Years of Observation.

WeberSpine (Phila Pa 1976)19831,149 citationsRCT

Surgical vs. Nonoperative Treatment for Lumbar Disk Herniation. The Spine Patient Outcomes Research Trial (SPORT): A Randomized Trial

Weinstein, Deyo, et al.JAMA20061,086 citationsRCT

Health and Function of Patients with Untreated Idiopathic Scoliosis: A 50-Year Natural History Study.

Weinstein, Ponseti, et al.JAMA2003755 citationsProspective cohort

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Comparison of Single versus Double Nerve Transfers for Elbow Flexion after Brachial Plexus Injury

Carlsen, Shin, et al.·Plast Reconstr Surg·2011·108 citations·Retrospective cohort

Background

Restoration of elbow flexion is commonly achieved with nerve transfer to the musculocutaneous nerve branches after upper trunk brachial plexus injury. It is unknown if double nerve transfer to the biceps and brachialis nerve branches results in greater strength than single nerve transfer to the biceps branch alone.

Methods

A retrospective review was performed of all patients receiving nerve transfer to restore elbow flexion.
Single and double nerve transfers were compared in regard to severity of injury, elbow flexion, supination, grip strengths, and Disabilities of the Arm, Shoulder, and Hand scores.
Elbow flexion and supination torque strength were measured quantitatively.

Results

55 patients underwent nerve transfer to restore elbow flexion (23 single, 32 double).
At similar follow-up periods, British Medical Research Council grade improved to 4 or better in 14 of 21 single and 24 of 30 double nerve transfer patients.
Supination strength was similar between groups (p = 0.148).
Grip strength was greater in the double nerve transfer patients (p = 0.028).
Preoperative Disabilities of the Arm, Shoulder, and Hand scores were significantly greater in single versus double nerve transfer patients (p = 0.018).
Although single nerve transfer patients had a greater improvement in scores, the final mean scores were similar in the 2 groups.
The severity of injury was different between the 2 groups, with 19 of 23 single nerve transfer patients having injury beyond the C5-6 level and only 16 of 32 of double nerve transfer patients with greater than C5-6 injury (p = 0.020).

Conclusions

Outcomes are similar between the two groups for elbow flexion and supination strength. Postoperative Disabilities of the Arm, Shoulder, and Hand scores are similar in single and double nerve transfer patients.

Copyright remains with the authors and publisher.

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