{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T08:58:44Z","timestamp":1790585924272,"version":"4.1.0"},"reference-count":30,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Supination posture is a common secondary deformity in brachial plexus birth injury (BPBI) that results in functional upper limb impairment. Radioulnar synostosis using a vascularized ulnar periosteal flap has recently been reported, with dorsal forearm scarring as the main reported disadvantage. This report evaluates outcomes in a series of children with forearm supination deformity and complete pronation palsy secondary to severe BPBI undergoing radioulnar synostosis in slight pronation using a novel proximal pedicled vascularized radial periosteal flap (VRPF).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We completed a retrospective analysis of patients with residual BPBI who underwent radioulnar synostosis with an antegrade proximally pedicled VRPF transfer to the volar ulna. The interosseous membrane was released when necessary, and the forearm was fixed in 10\u00b0\n                      <jats:italic>\u2013<\/jats:italic>\n                      20\u00b0 of pronation for 4\u2009weeks, using a Kirschner wire. Inclusion criteria included complete pronation paralysis, presence of active wrist extension, and a minimum of 6\u2009months follow\u2010up. Demographic information, preoperative passive pronation, postoperative forearm rotational position, radiographic union, and parental satisfaction using a 4\u2010point Likert\u2010type ordinal scale were evaluated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty\u2010one children with a mean age of 59\u2009months (range 24\u2013132\u2009months) were included in this report. Mean preoperative passive forearm pronation was \u22129\u00b0 (range \u221260\u00b0 to 45\u00b0) and mean follow\u2010up was 17.1\u2009months (range 9\u201332\u2009months). A partially ossified radioulnar synostosis was radiographically observed at 4\u2009weeks in all cases. Mean postoperative rotational position measured 20\u00b0 of pronation (range 0\u00b0\n                      <jats:italic>\u2013<\/jats:italic>\n                      30\u00b0). All parents expressed satisfaction with both functional and cosmetic outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Forearm fusion achieved by radioulnar synostosis using a proximally pedicled VRPF appears promising as an effective and rapid technique for correction of BPBI\u2010associated supination deformity and should be further explored in the management of residual supination deformity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/micr.70280","type":"journal-article","created":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T05:12:22Z","timestamp":1786165942000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Radioulnar Synostosis Using a Vascularized Pedicled Radial Periosteal Flap for Supination Deformity in Residual Brachial Plexus Birth Injury"],"prefix":"10.1002","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1759-9868","authenticated-orcid":false,"given":"Francisco","family":"Soldado","sequence":"first","affiliation":[{"name":"Department of Hand Surgery Children's Hospital of Soochow University  Suzhou Jiangsu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"D\u00edaz\u2010Gallardo","sequence":"additional","affiliation":[{"name":"Pediatric Orthopaedic Unit Hospital Sant Pau  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4411-404X","authenticated-orcid":false,"given":"Vivian","family":"Sinclair","sequence":"additional","affiliation":[{"name":"Bioengineering, Cell Therapy and Surgery in Congenital Malformations Laboratory, Vall d'Hebron Institut de Recerca Universitat Aut\u00f3noma de Barcelona  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ismaray","family":"De Avila\u2010Diaz","sequence":"additional","affiliation":[{"name":"Pediatric Orthopedic Unit Hospital Frank Pais  La Habana Cuba"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Villafranca\u2010Solano","sequence":"additional","affiliation":[{"name":"Department of Pediatric Orthopedics and Traumatology Hospital Universitario Son Espases  Palma Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9890-5080","authenticated-orcid":false,"given":"Jayme","family":"Bertelli","sequence":"additional","affiliation":[{"name":"Department of Surgery Federal University of Santa Catarina  Florianopolis Santa Catarina Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000141900.85203.ce"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1054\/JHSB.2001.0647"},{"key":"e_1_2_13_4_1","first-page":"300","article-title":"Osteoclasis for Supination Deformities in Children","volume":"22","author":"Blount P. 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