{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T22:16:20Z","timestamp":1790806580389,"version":"4.1.0"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T00:00:00Z","timestamp":1756166400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T00:00:00Z","timestamp":1756166400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002386","name":"Cairo University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002386","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Acta Neurochir"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Nerve transfers are a cornerstone in the surgical management of traumatic brachial plexus injuries (BPIs) to restore elbow flexion. Common donor nerves include intraplexal sources like the ulnar and median nerves (fascicular transfers) and extraplexal sources like the intercostal nerves (ICNs). Despite the widespread use of both techniques, the optimal donor nerve remains a subject of debate. This systematic review and meta-analysis aims to compare these techniques for restoring elbow flexion in BPIs.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A systematic search was conducted across PubMed, Embase, Cochrane Library, Scopus, and Web of Science to identify comparative studies. The quality of the studies included was assessed using the Newcastle\u2013Ottawa Scale (NOS). Meta-analyses were performed to compare motor recovery (\u2265\u2009M3), time to M3 recovery, and complication rates between the two surgical approaches.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>The analysis included 13 studies with a total of 537 patients. In the overall cohort, which included mixed injury patterns, fascicular transfers showed a statistically significant advantage for achieving\u2009\u2265\u2009M3 recovery (RR\u2009=\u20090.84, 95% CI [0.75, 0.94]). However, when the analysis was restricted to patients with only upper-BPIs, there was no significant difference in achieving\u2009\u2265\u2009M3 strength between fascicular and ICN transfers (RR\u2009=\u20090.92, 95% CI [0.82, 1.04]). Fascicular transfers resulted in a significantly faster time to\u2009\u2265\u2009M3 recovery by approximately five months (MD\u2009=\u20095.25, 95% CI [2.87, 7.62]). Donor-site morbidity (18 sensory, 10 motor deficits) and wrist co-flexion were reported in fascicular transfer groups, whereas pneumothorax (4 cases) was the primary complication for ICN transfers.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>In patients with upper-BPIs, fascicular and ICN transfers yield comparable elbow flexion strength. The choice of procedure is a trade-off between the faster recovery offered by fascicular transfers and the better rehabilitation course of ICN transfers.\n<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00701-025-06650-0","type":"journal-article","created":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T09:21:50Z","timestamp":1756200110000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Nerve transfer to musculocutaneous for elbow flexion restoration in brachial plexus injury (Ulnar and\/or Median vs. Intercostal): A systematic review and meta-analysis of comparative studies"],"prefix":"10.1007","volume":"167","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-8234-1557","authenticated-orcid":false,"given":"Mohamed K. A.","family":"Genedy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4640-4513","authenticated-orcid":false,"given":"Esraa Y.","family":"Salama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2050-215X","authenticated-orcid":false,"given":"Mohamed Ashraf","family":"Elsaadany","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5517-8205","authenticated-orcid":false,"given":"Mohamed A. F.","family":"AbdelWahab","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0433-8134","authenticated-orcid":false,"given":"Ahmed Fathy","family":"Amin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9826-6664","authenticated-orcid":false,"given":"Ahmed A.","family":"Lashin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7705-0335","authenticated-orcid":false,"given":"Ahmed O.","family":"Sabry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,26]]},"reference":[{"issue":"1","key":"6650_CR1","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1007\/s12306-024-00863-9","volume":"109","author":"AM Acharya","year":"2025","unstructured":"Acharya AM, Hegde N, Bhat AK (2025) The recovery and independence of elbow flexion and forearm supination after Oberlin II transfer in brachial plexus injuries: a long term follows up study. Musculoskelet Surg 109(1):97\u2013106","journal-title":"Musculoskelet Surg"},{"issue":"1","key":"6650_CR2","doi-asserted-by":"publisher","DOI":"10.1016\/j.oto.2025.101176","volume":"35","author":"SH Ahmed","year":"2025","unstructured":"Ahmed SH, Shekouhi R, Rais MS, Chim H (2025) Complete brachial plexus injuries: review of surgical techniques and functional outcomes. Oper Tech Orthop 35(1):101176","journal-title":"Oper Tech Orthop"},{"issue":"3","key":"6650_CR3","doi-asserted-by":"publisher","first-page":"41","DOI":"10.61186\/wjps.13.3.41","volume":"13","author":"A Bagheri","year":"2024","unstructured":"Bagheri A, Akbari H, Akbari P (2024) Evaluation and diagnostic-treatment approaches of brachial plexus injuries in adults. World J Plast Surg 13(3):41\u201348","journal-title":"World J Plast Surg"},{"issue":"2","key":"6650_CR4","doi-asserted-by":"publisher","first-page":"150","DOI":"10.4103\/0970-0358.59272","volume":"42","author":"PS Bhandari","year":"2009","unstructured":"Bhandari PS, Sadhotra LP, Bhargava P, Bath AS, Mukherjee MK, Bhatti T, Maurya S (2009) Surgical outcomes following nerve transfers in upper brachial plexus injuries. Indian J Plast Surg 42(2):150\u2013160","journal-title":"Indian J Plast Surg"},{"issue":"8","key":"6650_CR5","doi-asserted-by":"publisher","first-page":"818","DOI":"10.1177\/1753193420922184","volume":"45","author":"DSY Chia","year":"2020","unstructured":"Chia DSY, Doi K, Hattori Y, Sakamoto S (2020) Elbow flexion strength and contractile activity after partial ulnar nerve or intercostal nerve transfers for brachial plexus injuries. J Hand Surg Eur Vol 45(8):818\u2013826","journal-title":"J Hand Surg Eur Vol"},{"key":"6650_CR6","unstructured":"Cochrane Handbook for Systematic reviews of interventions | Cochrane. https:\/\/www.cochrane.org\/authors\/handbooks-and-manuals\/handbook. Accessed 3 July 2025"},{"issue":"8","key":"6650_CR7","doi-asserted-by":"publisher","first-page":"1297","DOI":"10.1016\/j.jhsa.2010.04.025","volume":"35","author":"B Coulet","year":"2010","unstructured":"Coulet B, Boretto JG, Lazerges C, Chammas M (2010) A comparison of intercostal and partial ulnar nerve transfers in restoring elbow flexion following upper brachial plexus injury (C5\u2013C6+\/-C7). J Hand Surg Am 35(8):1297\u20131303","journal-title":"J Hand Surg Am"},{"issue":"9","key":"6650_CR8","doi-asserted-by":"publisher","first-page":"1147","DOI":"10.1177\/17531934241232062","volume":"49","author":"CS Crowe","year":"2024","unstructured":"Crowe CS, Spinner RJ, Shin AY (2024) Global trends and outcomes of nerve transfers for treatment of adult brachial plexus injuries. J Hand Surg Eur Vol 49(9):1147\u20131156","journal-title":"J Hand Surg Eur Vol"},{"issue":"2","key":"6650_CR9","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1007\/s12306-020-00653-z","volume":"105","author":"M Emamhadi","year":"2021","unstructured":"Emamhadi M, Behzadnia H, Zamanidoust M, Baghi I, Ebrahimian R, Emamhadi R, Andalib S (2021) Intercostal or ulnar nerve: which donor nerve is to be used for reanimation of elbow flexion? Musculoskelet Surg 105(2):183\u2013188","journal-title":"Musculoskelet Surg"},{"key":"6650_CR10","unstructured":"GRADE handbook. https:\/\/gdt.gradepro.org\/app\/handbook\/handbook.html. Accessed 3 July 2025"},{"issue":"1","key":"6650_CR11","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1016\/j.jht.2021.06.008","volume":"36","author":"A Gushikem","year":"2023","unstructured":"Gushikem A, de Cardoso MM, Cabral ALL, Barros CSM, Isidro HBTM, Silva JR, Kauer JB, Soares RT (2023) Predictive factors for return to work or study and satisfaction in traumatic brachial plexus injury individuals undergoing rehabilitation: A retrospective follow-up study of 101 cases. J Hand Ther 36(1):103\u2013109","journal-title":"J Hand Ther"},{"key":"6650_CR12","first-page":"509","volume":"43","author":"F Hamza","year":"2019","unstructured":"Hamza F, Abdalkareem M, Ahmed R, Altamimy H, Nasef M, Eldosokey M (2019) Neurotization for elbow flexion restoration after brachial plexus injury. Egypt J Plast Reconstr Surg 43:509\u2013515","journal-title":"Egypt J Plast Reconstr Surg"},{"key":"6650_CR13","unstructured":"Homepage [The metafor Package]. https:\/\/metafor-project.org\/doku.php\/metafor. Accessed 3 Jul 2025"},{"issue":"4","key":"6650_CR14","doi-asserted-by":"publisher","first-page":"787","DOI":"10.1016\/j.injury.2020.02.076","volume":"51","author":"Y-H Hsueh","year":"2020","unstructured":"Hsueh Y-H, Tu Y-K (2020) Surgical reconstructions for adult brachial plexus injuries. Part I: treatments for combined C5 and C6 injuries, with or without C7 injuries. Injury 51(4):787\u2013803","journal-title":"Injury"},{"issue":"1","key":"6650_CR15","first-page":"4","volume":"5","author":"R Kakinoki","year":"2010","unstructured":"Kakinoki R, Ikeguchi R, Dunkan SF, Nakayama K, Matsumoto T, Ohta S, Nakamura T (2010) Comparison between partial ulnar and intercostal nerve transfers for reconstructing elbow flexion in patients with upper brachial plexus injuries. J Brachial Plex Peripher Nerve Inj 5(1):4","journal-title":"J Brachial Plex Peripher Nerve Inj"},{"issue":"3","key":"6650_CR16","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1142\/S2424835520500332","volume":"25","author":"GH-Y Kang","year":"2020","unstructured":"Kang GH-Y, Lim RQ-R, Yong F-C (2020) Elbow flexion reconstruction in brachial plexus avulsion injuries - results with intercostal nerve and distal nerve transfers. J Hand Surg Asian Pac 25(3):307\u2013314","journal-title":"J Hand Surg Asian Pac"},{"issue":"12","key":"6650_CR17","doi-asserted-by":"publisher","first-page":"1995","DOI":"10.1016\/j.jhsa.2010.09.013","volume":"35","author":"R Kovachevich","year":"2010","unstructured":"Kovachevich R, Kircher MF, Wood CM, Spinner RJ, Bishop AT, Shin AY (2010) Complications of intercostal nerve transfer for brachial plexus reconstruction. J Hand Surg Am 35(12):1995\u20132000","journal-title":"J Hand Surg Am"},{"issue":"2","key":"6650_CR18","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1055\/s-2007-1006662","volume":"40","author":"Y-H Lee","year":"2024","unstructured":"Lee Y-H, Lu JC-Y, Wong A, Chang TN-J, Chuang DC-C (2024) The evolution of the reconstructive strategy for elbow flexion for acute C5, C6 brachial plexus injuries over two decades. J Reconstr Microsurg 40(2):139\u2013144","journal-title":"J Reconstr Microsurg"},{"key":"6650_CR19","doi-asserted-by":"publisher","first-page":"107","DOI":"10.5312\/wjo.v4.i3.107","volume":"4","author":"M Lykissas","year":"2013","unstructured":"Lykissas M, Kostas-Agnantis I, Korompilias A, Vekris M, Beris A (2013) Use of intercostal nerves for different target neurotization in brachial plexus reconstruction. World Journal of orthopedics 4:107\u2013111","journal-title":"World Journal of orthopedics"},{"issue":"1","key":"6650_CR20","first-page":"1","volume":"23","author":"A Mohammad-Reda","year":"2013","unstructured":"Mohammad-Reda A (2013) Early post-operative results after repair of traumatic brachial plexus palsy. Turk Neurosurg 23(1):1\u20139","journal-title":"Turk Neurosurg"},{"key":"6650_CR21","doi-asserted-by":"crossref","unstructured":"Mandal MK, Singh P, Nayak BB, Patnaik AP (2021) Outcome of oberlin II versus intercostal nerve to musculocutaneous nerve transfer procedure for Elbow flexion in adult brachial plexus injury. Trop J Pharm Res 15(22):PC08-PC12","DOI":"10.7860\/JCDR\/2021\/51699.15637"},{"key":"6650_CR22","unstructured":"(n.d.) R: The R Project for Statistical Computing. https:\/\/www.r-project.org\/. Accessed 3 July 2025"},{"key":"6650_CR23","unstructured":"Ottawa Hospital Research Institute. https:\/\/www.ohri.ca\/programs\/clinical_epidemiology\/oxford.asp. Accessed 3 July 2025"},{"key":"6650_CR24","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71","volume":"372","author":"MJ Page","year":"2021","unstructured":"Page MJ, McKenzie JE, Bossuyt PM et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71","journal-title":"BMJ"},{"issue":"6","key":"6650_CR25","doi-asserted-by":"publisher","first-page":"1095","DOI":"10.1016\/j.otsr.2020.03.033","volume":"106","author":"L Pages","year":"2020","unstructured":"Pages L, Le Hanneur M, Cambon-Binder A, Belkheyar Z (2020) C5\/C6 brachial plexus palsy reconstruction using nerve surgery: long-term functional outcomes. Orthop Traumatol Surg Res 106(6):1095\u20131100","journal-title":"Orthop Traumatol Surg Res"},{"key":"6650_CR26","unstructured":"Rayyan-a web and mobile app for systematic reviews - PubMed. https:\/\/pubmed.ncbi.nlm.nih.gov\/27919275\/. Accessed 3 Jul 2025"},{"issue":"1","key":"6650_CR27","doi-asserted-by":"publisher","DOI":"10.1016\/j.hansur.2025.102080","volume":"44","author":"M Romeih","year":"2025","unstructured":"Romeih M, Mazrou IA (2025) Comparing the long-term results of Oberlin II versus intercostal neurotization for elbowflexion restoration (prospective study). Hand Surg Rehabil 44(1):102080","journal-title":"Hand Surg Rehabil"},{"key":"6650_CR28","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/314137","volume":"2014","author":"VI Sakellariou","year":"2014","unstructured":"Sakellariou VI, Badilas NK, Stavropoulos NA, Mazis G, Kotoulas HK, Kyriakopoulos S, Tagkalegkas I, Sofianos IP (2014) Treatment options for brachial plexus injuries. ISRN Orthop 2014:314137","journal-title":"ISRN Orthop"},{"key":"6650_CR29","doi-asserted-by":"publisher","unstructured":"Schwarzer G, Carpenter JR, R\u00fccker G (2015) Meta-Analysis with R. https:\/\/doi.org\/10.1007\/978-3-319-21416-0","DOI":"10.1007\/978-3-319-21416-0"},{"issue":"1","key":"6650_CR30","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1016\/j.hcl.2004.10.002","volume":"21","author":"P Songcharoen","year":"2005","unstructured":"Songcharoen P, Wongtrakul S, Spinner RJ (2005) Brachial plexus injuries in the adult. Nerve transfers: the Siriraj Hospital experience. Hand Clin 21(1):83\u201389","journal-title":"Hand Clin"},{"issue":"4","key":"6650_CR31","doi-asserted-by":"publisher","first-page":"375","DOI":"10.25122\/jml-2025-0079","volume":"18","author":"C-V Vancea","year":"2025","unstructured":"Vancea C-V, Hodea F-V, Bordeanu-Diaconescu E-M, Cacior S, Dumitru C-S, Ratoiu V-A, Stoian A, Lascar I, Zamfirescu D (2025) Functional outcomes following nerve transfers for shoulder and elbow reanimation in brachial plexus injuries: a 10-year retrospective study. J Med Life 18(4):375\u2013386","journal-title":"J Med Life"},{"issue":"3","key":"6650_CR32","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1016\/j.jhsa.2022.11.013","volume":"48","author":"CY Vernon Lee","year":"2023","unstructured":"Vernon Lee CY, Cochrane E, Chew M, Bains RD, Bourke G, Wade RG (2023) The effectiveness of different nerve transfers in the restoration of elbow flexion in adults following brachial plexus injury: a systematic review and meta-analysis. J Hand Surg Am 48(3):236\u2013244","journal-title":"J Hand Surg Am"},{"issue":"8","key":"6650_CR33","doi-asserted-by":"publisher","first-page":"849","DOI":"10.1016\/j.jclinepi.2006.11.003","volume":"60","author":"SD Walter","year":"2007","unstructured":"Walter SD, Yao X (2007) Effect sizes can be calculated for studies reporting ranges for outcome variables in systematic reviews. J Clin Epidemiol 60(8):849\u2013852","journal-title":"J Clin Epidemiol"},{"key":"6650_CR34","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-14-135","volume":"14","author":"X Wan","year":"2014","unstructured":"Wan X, Wang W, Liu J, Tong T (2014) Estimating the sample mean and standard deviation from the sample size, median, range and\/or interquartile range. BMC Med Res Methodol 14:135","journal-title":"BMC Med Res Methodol"}],"container-title":["Acta Neurochirurgica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00701-025-06650-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00701-025-06650-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00701-025-06650-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T06:17:18Z","timestamp":1757485038000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00701-025-06650-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,26]]},"references-count":34,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["6650"],"URL":"https:\/\/doi.org\/10.1007\/s00701-025-06650-0","relation":{},"ISSN":["0942-0940"],"issn-type":[{"value":"0942-0940","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,26]]},"assertion":[{"value":"7 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 August 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 August 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This article does not contain any studies with human participants or animals performed by any of the authors. As this is a systematic review and meta-analysis of existing literature, institutional review board approval was not required.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"229"}}