Dynamic Compression System versus Self-Adjustable Bracing for Pectus Carinatum: Clinical Outcomes and Cost Comparison

Bracing is the preferred treatment for pectus carinatum. However, few studies have compared outcomes of different bracing methods. We tested the hypothesis that the type of brace has no effect on outcomes.

A retrospective study of children who underwent bracing during a 10-year period (2011-2021) at a multidisciplinary chest wall anomaly center was conducted. The characteristics and outcomes of patients treated with a pressure-guided orthotist-adjusted brace (FMF Dynamic Compression System [DCS]) were compared with those treated with a simpler, less costly, self-adjustable brace (Trulife). Pressure of correction (POC) was used to assess severity. A standardized follow-up protocol was used. Patients who were still in active bracing or had inadequate follow-up were excluded.

During the study period, 373 patients started bracing, with 241 (93.7% males) having sufficient data to assess outcomes (170 DCS, 71 Trulife). Bracing succeeded in 217 patients (90%). Of 24 patients who failed, the majority (17) were due to non-compliance. There were no significant differences in POC (DCS 5.27 ± 1.59 vs. Trulife 4.99 ± 1.62 psi, p = 0.219) or any other characteristics between the groups. Bracing success (DCS 89% vs. Trulife 93%, p = 0.329) and active bracing duration (5.41 ± 3.52 vs. 5.37 ± 4.28 months, p = 0.944) were similar between the two groups. Loss to follow-up was significantly higher in the Trulife group (40.7% vs. 23.7%). Use of the Trulife brace resulted in a cost savings of CAD 406,000.00.

With the limitations of a retrospective study, a self-adjustable brace resulted in a similar success rate and bracing duration, when compared with a pressure-guided orthotist-adjusted brace, and was associated with substantial cost savings.

IV.