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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.

Children (Basel, Switzerland)
|April 27, 2024
PubMed

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.
Abstract

Keywords:
CWIGchildrencompressive bracingpectus carinatumsurvey

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