Bracing of Pectus Carinatum in Children: Current Practices
Pavol Omanik1, Sergio Bruno Sesia2, Katarina Kozlikova3
1Department of Pediatric Surgery, National Institute of Children's Diseases, 83340 Bratislava, Slovakia.
Insights
Compressive orthotic bracing (COB) is a primary treatment for pectus carinatum (PC), showing high compliance. Standardization and extended follow-up are recommended to improve COB effectiveness, especially during puberty.
Area of Science:
- Pediatric Orthopedics
- Thoracic Surgery
- Biomedical Engineering
Background:
- Compressive orthotic bracing (COB) is effective for pectus carinatum (PC) but lacks standardized protocols.
- Current practices in COB for pediatric PC are varied.
- The Chest Wall International Group (CWIG) initiated a study to analyze these practices.
Purpose of the Study:
- To analyze current practices in the diagnosis and treatment of pectus carinatum using compressive orthotic bracing among CWIG members.
- To identify variations in COB protocols, including diagnostic work-up, age indications, bracing types, and treatment duration.
- To assess treatment outcomes, complications, and recurrence rates associated with COB for pediatric PC.
Main Methods:
- A web-based questionnaire was distributed to 208 CWIG member departments.
- The questionnaire comprised 30 questions covering diagnostic work-up, COB indication age, bracing type, wearing time, treatment duration, complications, and recurrence.
- Responses were collected from 44 departments, yielding a 21.2% institutional response rate.
Main Results:
- 93% of respondents consider COB the first-line treatment for PC.
- Conventional COB (CC) is used by 59%, while dynamic compression systems (FMF) are used by 41%.
- Compliance exceeds 80%; however, actual wearing time is less than recommended (p < 0.01). FMF shows faster response than CC (p < 0.01). Recurrence rates vary, with 61% reporting 10-30% recurrence.
Conclusions:
- COB is a widely accepted first-line treatment for PC with high patient compliance.
- A significant recurrence rate is observed during puberty.
- Standardizing COB treatment and extending follow-up through puberty are crucial for enhancing treatment efficacy.
Background:
Although effective, compressive orthotic bracing (COB) in children with pectus carinatum is still not standardized. This study has aimed to analyze current practices amongst members of the Chest Wall International Group (CWIG).
Methods:
A web-based questionnaire was mailed to all CWIG members at 208 departments. It included 30 questions regarding diagnostic work-up, age for COB indication, type of COB used, daily wearing time, treatment duration, complications, and recurrence rate.
Results:
Members from 44 departments have responded (institutional response rate 21.2%). A total of 93% consider COB as the first-line treatment for PC. A conventional COB (CC) is used in 59%, and the dynamic compression system (FMF) in 41%. The overall compliance rate is >80%. A total of 67% of responders consider COB to be indicated in patients <10 years. The actual wearing time is significantly shorter than the physician-recommended time (p < 0.01). FMF patients experience a significantly faster response than CC patients (p < 0.01). No recurrence of PC has been noted in 34%; recurrence rates of 10-30% have been noted in 61%.
Conclusions:
COB is the first-line treatment for PC with a high compliance rate. During puberty, the recurrence rate is high. Treatment standardization and follow-up until the end of puberty are recommended to enhance COB effectiveness.
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