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Nonoperative management of pectus carinatum

Ala Stanford Frey1, Victor F Garcia, Rebeccah L Brown

  • 1Division of General and Thoracic Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.

Journal of Pediatric Surgery
|January 18, 2006
PubMed

Insights

Compression bracing is a safe and effective nonoperative treatment for children with chondrogladiolar pectus carinatum (PC). This approach is now a first-line option, with surgery reserved for noncompliant patients or those who do not respond to bracing.

Area of Science:

  • Pediatric Orthopedics
  • Thoracic Surgery
  • Biomechanical Engineering

Background:

  • Surgery has been the primary treatment for chondrogladiolar pectus carinatum (PC).
  • Nonoperative approaches, particularly compression bracing, are increasingly recognized for their potential in chest wall remodeling.
  • This study integrates compression bracing into the treatment algorithm for PC.

Purpose of the Study:

  • To evaluate the efficacy and safety of compression bracing as a treatment for chondrogladiolar pectus carinatum (PC).
  • To compare outcomes of nonoperative bracing with observation and surgical repair.
  • To establish compression bracing as a first-line treatment modality.

Main Methods:

  • Retrospective chart review of pediatric patients diagnosed with PC between 1997 and 2004.
  • Patients were managed via observation, operative repair, or orthotic bracing with continuous anteroposterior sternal compression.
  • Brace wear was prescribed for 14-16 hours daily until skeletal maturity or for a minimum of 2 years.

Main Results:

  • 100 patients diagnosed with PC; 57 observed, 29 braced, 17 surgically repaired.
  • 90% compliance rate among patients fitted with a brace.
  • All patients treated with bracing (26/29) and surgery (17/17) demonstrated positive outcomes without major complications.

Conclusions:

  • Compression bracing is a safe and effective treatment for pediatric chondrogladiolar pectus carinatum (PC).
  • This nonoperative modality is recommended as a first-line treatment.
  • Surgery is reserved for patients who are noncompliant with bracing or fail nonoperative management.
Abstract

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