984 The Efficacy of Different Nerve Transfers to Restore Elbow Flexion in Adults Following Brachial Plexus Injury: A Systematic Review and Meta-Analysis

Abstract Aim There are numerous donors available for neurotisation of the musculocutaneous nerve, following traumatic brachial plexus injury (BPI). However, there is uncertainty over which method is most effective for restoring elbow flexion. We set out to summarise and compared different nerve transfers for restoring elbow flexion after traumatic BPI in adults. Method Medline, Embase, medRxiv and bioRxiv were systematically searched from inception to 12 th April 2021. Studies reporting outcomes of nerve transfers to restore elbow flexion in adults were included. BPIs were categorised as partial or pan plexus. The primary outcome was ≥M4 elbow flexion on the British Medical Research Council (BMRC) scale. Results We included 64 articles, describing 13 different nerve transfers. There were 1335 adults with 813 (61%) partial and 522 (39%) pan plexus injuries. 75% of patients with partial BPIs achieved ≥M4 (95% CI 69%-80%); double Oberlin or two intercostal nerves appeared to give recovery. For patients with pan plexus injuries, 45% achieved ≥M4 (95% CI 31%-60%) and each month delay from injury to reconstruction reduced the probability of achieving ≥M4 by 7% (95% CI 1%-12%) where intercostal, phrenic or spinal accessory nerves were used as donors. Conclusions The choice of donor nerve affects the chance of attaining BMRC ≥4 in upper trunk reconstruction. For patients with pan plexus injuries, delay to neurotisation appears to be detrimental to motor outcome. This information may help clinicians and patients reach shared decisions about the choice of donor nerve(s) and the timing of surgery.