PMC4258343_01
The patient (8 months old) with severe obstetric brachial plexus injury with bent elbow, shorter arm with internal rotation of the shoulder.
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fig1
The patient initially presented to us when she was 8 months old with severe obstetric brachial plexus injury (Figure 1).
Clinical photograph of the patient after multiple surgeries at an outside hospital but before triangle tilt surgery (a) and 2 months after triangle tilt surgery (b), showing significant improvement in resting arm posture.
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The post-triangle tilt pictures of the patient are presented in Figures 2(b), 3(b), and 3(c).
Functional movement picture of the patient after multiple surgeries at an outside hospital but before triangle tilt surgery (a) and 2 months after triangle tilt surgery (b), showing improvement in hand to mouth movement.
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fig3
The post-triangle tilt pictures of the patient are presented in Figures 2(b), 3(b), and 3(c).
Radiological picture of the patient after multiple surgeries at an outside hospital but before triangle tilt surgery, showing SHEAR deformity.
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fig4
Instead, the child was referred to another surgeon by her insurance company for treatment, where she underwent the following operations over 5+ years' time:This patient had persistent internal rotation deformity (among many other ongoing problems) related, by preoperative clinical examination and radiological studies, to an elevated scapula with forward rotation (Figure 4), the SHEAR deformity.