Outcomes of Elbow Flexion Reconstruction in Patients Over 50 with Traumatic Brachial Plexus Injury

Background: There is controversy regarding the effectiveness of brachial plexus (BP) reconstruction for elbow function in older patients as reported outcomes are generally poor. The purpose of this study is to evaluate elbow function outcomes in patients over 50. Methods: Fifty-eight patients over the age of 50 underwent nerve grafting, transfers or free functioning muscle transfer (FFMT) to improve elbow function after traumatic BP injury. Patients were evaluated pre- and post-operatively for elbow flexion strength and range of motion (ROM), Disability of the Arm, Shoulder, and Hand (DASH) scores, pain, delay from injury to operation, concomitant trauma, severity of trauma, and type of reconstruction. Results: The average age was 57.8 years (range 50-72) with an average follow-up of 24.0 months. The average modified BMRC (British Medical Research Council) elbow flexion grade improved significantly from 0.26 to 2.63. Thirty-three patients (60%) achieved functional flexion ≥M3 post-operatively, compared to zero patients pre-operatively. There was no correlation between age and modified BMRC grade. Active elbow ROM improved significantly post-operatively, with no effect of age on flexion motion. More patients achieved ≥M3 flexion with nerve transfers (69%) compared to FFMT (43%). Patients had worse outcomes with high energy injuries. The mean DASH score decreased from 51.5 to 49.6 post-operatively and the average pain score decreased from 5.0 to 4.3. Conclusion: BP reconstruction for elbow function in patients over the age of 50 can yield useful flexion. Conflicts of Interest: We have no conflicts of interest or financial interest to disclose. Corresponding author: Alexander Shin, MD, shin.alexander@mayo.edu, Division of Orthopedic Surgery, Mayo Clinic, 200 First Street, SW, 55905 Rochester, MN ©2018American Society of Plastic Surgeons