Triple tendon transfer for an irreparable 10-cm radial nerve defect: a case report of functional recovery and a successful return to work as a waiter.

Introduction: Radial nerve palsy following humeral shaft fractures is common, but management of massive nerve gaps remains a challenge. While nerve grafting is an option, defects exceeding 10 cm often yield poor results. Case presentation: We report the case of an 18-year-old male, a chronic smoker, who sustained a complete 10-cm radial nerve loss; management consisted of a triple tendon transfer. Results: At 14 months, he achieved complete extension and successfully returned to his demanding professional activity. Discussion: The use of the flexor carpi ulnaris for digital and thumb extension, combined with transfer of the pronator teres to the extensor carpi radialis brevis for wrist balance, allowed restoration of both power and stability. These results support tendon transfer as a preferred option for large nerve defects when early functional recovery is the priority. Conclusion: The patient's smoking status, combined with a 10-cm nerve gap, favored tendon transfer as a reliable option for immediate and predictable functional restoration in massive radial nerve defects.