Facebook Twitter YouTube

16898

Compressive Orthotic Bracing: A Conservative Treatment Paradigm for Pectus Carinatum

Saturday, October 20, 2012
Napoleon Ballroom (Hilton Riverside)
Elizabeth A. Berdan, M.D.1, Joseph MacDonald, BS2, Donavon J. Hess, M.D., Ph.D.3, Robert D. Acton, M.D.3, Bradley J. Segura, M.D., Ph.D.3, Melanie Hanlon, R.N., P.N.P.3 and Daniel A. Saltzman, M.D., Ph.D.3, (1)Department of Surgery, University of Minnesota, Minneapolis, MN, (2)Medical School, University of Minnesota, Minneapolis, MN, (3)Department of Surgery, Division of Pediatric Surgery, University of Minnesota, Minneapolis, MN

Purpose

The correction for pectus carinatum (PC) is largely cosmetic. Studies suggest the outer physical appearance of children with anterior chest wall deformities may have a substantial impact on social interaction and stigmatization (Steinmann, 2011; Roberts 2003). Orthotic braces have enabled non-operative management in the majority of patients with PC (Figure 1). While there are small studies describing the use of bracing to treat PC, there are a variety of treatment approaches used.  The purpose of this study was to evaluate the treatment of pectus carinatum by compressive orthotic bracing. 

Methods

A retrospective review of 97 children between the years of 2009 and 2011 at 2 tertiary hospitals was conducted to assess the treatment of PC with a compressive orthotic chest brace for correction and complications. Patients were offered a choice of bracing treatment: 8-12 hours at night for a longer total duration or 23 hours per day for a shorter total duration of treatment. See figure 2 for examples of patients pre-orthotic brace treatment and post-orthotic brace treatment.

Results

There were 97 children evaluated in the pediatric surgery clinic for PC. The mean age was 12 years (2-18 years; 80 (83%) boys, 17 girls (17%)). Of the original 97 children 11 underwent elective operative repair due to complex anterior chest wall malformations or a non-compressive PC. 10 children did not return to obtain the chest brace. 48 children underwent compressive bracing of the anterior chest. 16 had not completed their treatment and 9 obtained the brace but were lost to follow up. For the remaining 23 patients who completed bracing treatment the mean duration of treatment was 23 8 months. The brace was worn for 8 23 hours of the day (depending on patient choice and comfort). Reported complications of the brace included: skin irritation (n = 2), back pain (n = 1) and chest discomfort (n = 3). Minimal to no correction of the anterior chest wall malformation was reported in 6 (26%) patients secondary to complications of the brace resulting in non-compliance of the treatment regimen. Correction of pectus carinatum was achieved by orthotic brace in 17 (74%) patients. 

Conclusion

Compressive orthotic chest bracing for pectus carinatum is an effective treatment for patients who have not yet reached skeletal maturity. We describe a conservative treatment paradigm that yields satisfactory patient compliance and excellent corrective outcomes. Our preliminary data supports the use of bracing restricted to nocturnal use for the treatment of PC. This treatment option may positively impact compliance and reduce the psychological stress of wearing a brace while at school and in the presence of peers.

Figure 1. Orthotic chest brace.

Figure 2. A) Pectus carinatum pre-orthotic brace treatment. B) Pectus carinatum post-orthotic brace treatment.