Pectus carinatum bracing: key factors in success and dropout.

PURPOSE: Pectus carinatum (PC) is a prevalent chest wall deformity mostly managed with orthotic bracing. Despite the effectiveness, research identifying specific predictors of treatment success remains limited. This study evaluates clinical findings from external bracing to propose a reliable indicator for predicting successful outcomes. METHODS: A comprehensive assessment was conducted on a large cohort of patients presenting to a specialized clinic during 2019 to 2024 May. Evaluations included demographics, deformity characteristics, and the “initial force of correction” measured at first examination (1FOC). Patients complying with treatment received custom-made orthoses. During the first follow-up, the force of correction was re-measured (2FOC). RESULTS: Patients were mostly male and adolescent. While 1FOC correlated with age, the analysis revealed that neither patient age nor initial deformity severity were distinguishing factors between successful and unsuccessful outcomes. Instead, success was strongly associated with the chest wall’s early response to bracing. Specifically, patients who exhibited a significant reduction in FOC during their first follow-up visit were the most likely to achieve full correction. CONCLUSION: Orthotic success in PC depends largely on the chest wall’s dynamic response to treatment rather than static factors like age or initial severity. Consequently, external bracing should be offered to all motivated patients, using the first follow-up assessment as a critical guide for predicting long-term success.