Clinical experience with orthotic repair of pectus carinatum

Abstract

Background: Pectus carinatum is a congenital chest wall deformity characterized by protrusion of the sternum and adjacent costal cartilages. Multiple treatment options are available for correction of pectus carinatum. Ob jective: We report our initial experience with first-line treatment using a custom fitted dynamic compression orthosis. Design: Prospective evaluation of all patients seen between November 2013 and December 2014. Setting: University hospital. Patients and Methods: The treatment protocol for patients who had pressure for initial correction ≤7.5 psi included a custom-fitted and adjusted dynamic compression orthosis and frequent clinic visits. Patient satisfaction was assessed after 12 months. MAIN OUTCOME MEASURES: Patient satisfaction score. Results: Eighteen patients (17 male and 1 female) (age: mean, 15.5 y; range, 10-23 y) completed treatment or continued in the study. Mean pressure for initial correction was 4.5 psi (range, 2.2-7.3 psi), bracing time was 12.8 hours/day (range, 8-24 h/d), and satisfaction score was 3 (scale: no correction, 0; complete correction, 4). There was complete correction in 7 patients (39%), remarkable improvement in 5 patients (28%), minimal improvement in 3 patients (17%) , and no correction in 3 patients (17%). There were no major complications. Conclusion: Treatment with dynamic compression orthosis for chondrogladiolar pectus carinatum provided favorable outcomes in compliant patients. We recommend this as first-line treatment for this condition. Limitations: No objective findings. Satisfaction scores are subjective. We recommend chest CT for follow up and use of a radiological tool for comparison.