Outcomes of Oberlin Transfer in Elderly Patients: A Case Series

Objective: A case series analysis was performed of upper brachial plexus injuries (BPIs) from low-impact trauma in patients ≥60 years old to assess the effectiveness of nerve transfers, particularly the Oberlin technique, in restoring elbow flexion and to refine clinical decision making for managing traumatic BPIs in this age group.

Methods: Between 2013 and 2024, 11 patients aged 60-72 with traumatic upper BPIs underwent Oberlin technique for elbow flexion; all were evaluated with consistent postsurgical criteria.

Results: Trauma mechanisms included falls (55%), direct trauma (27%), knife wounds (9%), and stretching (9%), with no high-impact trauma cases. Injuries predominantly affected the right side (55%). Elbow flexion strength was assessed using the British Medical Research Council scale. Positive Tinel sign was present in 73% of patients, all reporting pain ranging from mild to severe. At 1 year postsurgery, 64% achieved M4 elbow flexion, 27% achieved M3, and 9% achieved M1 after 4 months. Patients >65 who received surgery within 6 months of injury showed better outcomes except for 1 case. No ulnar nerve deficits were observed. Following surgery, 36% experienced no pain, whereas 64% reported mild pain. Additionally, 64% underwent further nerve transfers to restore shoulder function (spinal accessory nerve to suprascapular nerve), and 18% underwent the Somsakprocedure for deltoid function.

Conclusions: Positive outcomes were achieved with the Oberlin technique in patients >60 with upper BPIs from low-energy trauma. However, delayed surgery, significant atrophy, and low testosterone levels may affect results. Evaluation of each patient's medical history is crucial before performing this procedure.