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Efficacy and Safety of Oberlin's Procedure in the Treatment of Brachial Plexus Birth Palsy

Siqueira, Mario G. MD, PhD*; Socolovsky, Mariano MD, PhD; Heise, Carlos Otto MD, PhD*; Martins, Roberto S. MD, PhD*; Di Masi, Gilda MD

doi: 10.1227/NEU.0b013e318271ee4a
Research-Human-Clinical Studies

BACKGROUND: In brachial plexus injuries, when there are no available roots to use as a source for graft reconstruction, nerve transfers emerge as an elective technique. For this purpose, transfer of an ulnar nerve fascicle to the biceps motor branch (Oberlin's procedure) is often used. Despite the high rate of good to excellent results in adults, this technique is seldom used in children.

OBJECTIVE: To evaluate the efficacy and safety of Oberlin's procedure in the surgical treatment of brachial plexus birth palsy.

METHODS: Striving to restore elbow flexion, we performed Oberlin's procedure in 17 infants with brachial plexus birth palsy. After follow-up of at least 19 months, primary outcomes were the strength of elbow flexion (modified British Medical Research Council Scale), hand function measured using Al-Qattan’s Scale, and comparative x-rays of both hands to detect altered growth.

RESULTS: Good to excellent results related to biceps contraction were obtained in 14 patients (82.3%) (3/MRC3, 11/MRC4). The preoperative Al-Qattan Scale score for the hand was maintained at final follow-up. Comparing the treated and normal limb, no difference was observed in hand development by x-ray.

CONCLUSION: Oberlin's procedure is an effective and safe option for the surgical treatment of upper brachial plexus birth palsy.

ABBREVIATION: mBMRC, modified British Medical Research Council Grading System

*Peripheral Nerve Surgery Unit, Department of Neurosurgery, University of São Paulo Medical School, São Paulo, SP, Brazil

Peripheral Nerve and Plexus Surgery Program, Division of Neurosurgery, University of Buenos Aires, Buenos Aires, Argentina

Correspondence: Mario G. Siqueira, MD, PhD, Peripheral Nerve Surgery Unit, Department of Neurosurgery, University of São Paulo Medical School, Rua Virgilio de Carvalho Pinto, 381/ap. 42, 05415-030 São Paulo, SP, Brazil. E-mail:

Received March 03, 2012

Accepted August 23, 2012

Copyright © by the Congress of Neurological Surgeons