Anterior interosseous to extensor carpi radialis brevis nerve transfer for wrist extension in brachial plexus birth injury

Brachial plexus birth injuries (BPBI) affecting the C5 to C8 nerve roots commonly impair wrist extension, making its restoration a key goal of reconstruction. However, children with persistent wrist extension paralysis have limited surgical options, particularly in the setting of extensive plexus injury. Notably, infants with C5-C8 injuries often lose wrist extension while preserving median nerve function due to intact T1 contributions. We report two infants in whom wrist extension was successfully restored using an anterior interosseous nerve-to-extensor carpi radialis brevis (AIN-ECRB) nerve transfer.