Nerve Transfer for Elbow Extension in Obstetrical Brachial Plexus Palsy.

Dear Editor, The aim of this paper is to demonstrate the option of triceps muscle restoration by means of selective neurotisation of the radial nerve in children suffering from obstetrical brachial plexus palsy (OBPP) during their early years of life. Early nerve surgery, which includes both brachial plexus reconstruction and nerve transfers, is generally accepted as the best option for treating children suffering from severe OBPP in their fi rst months of life. As a matter of fact, nerve surgery is performed in order to achieve a higher potential of sensory and motor recovery in those children who would otherwise be doomed to an unfavourable outcome.1,2 Despite the option for early nerve surgery during growth, there is a large group of patients who are still showing signs of unsatisfactory recovery of upper limb function. In the said patients, the muscles are seldom completely denervated due to some regeneration of axons across the neuroma. Consequently, nerve transfers should be considered in these cases, keeping in mind that nerve surgery performed later than the fi rst months of life, especially when nerve transfers are done in the following years, should be considered as a real delayed surgery, because nerve surgery should be performed as early as possible.3,4 The restoration of shoulder abduction and external rotation, elbow fl exion, and prehension are the main goals of brachial plexus repair in infants, while elbow extension recovery has not been emphasised enough in the literature. However, a strong triceps muscle is fundamental to stabilise the elbow and allow greater reach. Wrist extension is also useful for a better grasp. We present a case series of 10 patients, who underwent nerve surgery for restoration of elbow extension by means of neurotisation of the radial nerve in different ages after birth palsy (Table 1).