Restoring elbow flexion following brachial plexus injury (BPI) is essential for improving arm function and quality of life in adults. This study aimed to compare the efficacy of Oberlin II and intercostal nerve (ICN) neurotization techniques for restoring elbow flexion in adults with upper and middle trunk brachial plexus palsy.

This prospective study included 36 patients aged 18 to 50 years with traumatic upper and middle trunk brachial plexus palsy. The patients were divided into two groups: Group A consisted of 19 patients who underwent the Oberlin II procedure, while Group B included 17 patients treated with ICN neurotization. All patients were followed for at least 60 months.

Muscle reactivation occurred significantly earlier in the Oberlin II group compared to the ICN neurotization group (P = 0.012). Muscle strength grading also showed significant differences, with a higher proportion of patients achieving grade 4 and 4+ strength in the Oberlin II group compared to the ICN neurotization group (P = 0.041).

The Oberlin II neurotization technique demonstrated superior efficacy in restoring elbow flexion following BPI compared to ICN neurotization. It resulted in earlier muscle reactivation and higher levels of muscle strength, with a greater proportion of patients achieving grades 4 and 4+ strength.