Compressive orthotics in the treatment of asymmetric pectus carinatum: a preliminary report with an objective radiographic marker.

BACKGROUND/PURPOSE: Pectus carinatum (PC) traditionally has been managed with surgical reconstruction. Compressive orthosis also has resulted in subjective improvement in this defect. The goal of the authors was to develop an alternative brace and an objective radiographic marker to monitor the effects of chest wall compression on sternal protrusion.

METHODS

Baseline chest computed tomography (CT) scans were obtained for 5 teenage boys with chondrogladiolar type of PC. The angle at the point of greatest sternal rotation was measured as the baseline deformity. Compressive orthosis was initiated using a custom-fitted brace. Follow-up chest CT scans were obtained to document change in sternal rotation.

RESULTS

One patient was lost to follow-up after 6 months with subjective improvement. Another opted for surgical correction after 3 months, having shown a 16% decrease in sternal rotation preoperatively. Two patients showed subjective improvement corroborated by 33% and 44% decreases in sternal rotation. The fifth patient, who discontinued bracing after 1 month, showed a 25% increase 6 months later.

CONCLUSIONS

Preliminary results indicate a potential role for compressive orthosis in the management of pectus carinatum. The objective radiographic marker described may be used to monitor the effects of growth or treatment with compressive orthosis.