Effectiveness of Compressive External Bracing in Patients with Flexible Pectus Carinatum Deformity: A Review

Abstract

There has been a growing interest in the nonoperative treatment of chest wall deformities over the last few decades; with the advent of external compressive orthotics, similar outcomes have been reported compared with surgical intervention. There have been fewer major complications reported with dynamic compression bracing on the chest wall; however, the Achilles heel of this approach still lies with treatment tolerability and compliance. A Medline literature search was undertaken to evaluate the evidence concerning the techniques, modifications, and outcomes associated with external compressive bracing in the setting of pectus carinatum. Sixteen articles were integrated after literature review and data were collected on methods of assessing pectus carinatum (degree of severity as well as type), patient selection protocol (i.e., suitability for external compressive bracing), the bracing protocol itself, duration of treatment, metrics used to assess outcome, and success, compliance, and dropout rate, and length of long-term follow-up. Compressive external bracing appears to be a safe and well tolerated nonsurgical treatment option for young patients with flexible pectus carinatum deformities. However, there is still a need for robust level I randomized data from multiple centers with a clearly standardized bracing protocol, objective measurement of outcomes, and recording of results at the end of the bracing treatment program in sufficiently powered sample sizes over a significant follow-up period.

Keywords

pectus carinatum - external compressive bracing - dynamic compression brace - Haller's index

Disclosures

There were no funding sources used to support this study. All the authors had the freedom of investigation and full control of the design of this study including methods used, decision on outcome parameters, results, data analysis, and production of the written report. No grants or financial support was sought for this project and in the construction of this manuscript.

• References

• 1 Haje SA, Bowen JR. Preliminary results of orthotic treatment of pectus deformities in children and adolescents. J Pediatr Orthop 1992; 12 (06) 795-800
• 2 Stephenson JT, Du Bois J. Compressive orthotic bracing in the treatment of pectus carinatum: the use of radiographic markers to predict success. J Pediatr Surg 2008; 43 (10) 1776-1780
• 3 Banever GT, Konefal SH, Gettens K, Moriarty KP. Nonoperative correction of pectus carinatum with orthotic bracing. J Laparoendosc Adv Surg Tech A 2006; 16 (02) 164-167
• 4 Martinez-Ferro M, Fraire C, Bernard S. Dynamic compression system for the correction of pectus carinatum. Semin Pediatr Surg 2008; 17 (03) 194-200
• 5 de Beer SA, Gritter M, de Jong JR, van Heurn ELW. The Dynamic compression brace for pectus carinatum: intermediate results in 286 patients. Ann Thorac Surg 2017; 103 (06) 1742-1749
• 6 Loff S, Sauter H, Wirth T, Otte R. Highly efficient conservative treatment of pectus carinatum in compliant patients. Eur J Pediatr Surg 2015; 25 (05) 421-424
• 7 Sesia SB, Holland-Cunz S, Häcker F-M. Dynamic compression system: an effective nonoperative treatment for pectus carinatum: a single center experience in Basel, Switzerland. Eur J Pediatr Surg 2016; 26 (06) 481-486
• 8 Poola AS, Pierce AL, Orrick BA. , et al. A single-center experience with dynamic compression bracing for children with pectus carinatum. Eur J Pediatr Surg 2018; 28 (01) 12-17
• 9 Cohee AS, Lin JR, Frantz FW, Kelly Jr RE. Staged management of pectus carinatum. J Pediatr Surg 2013; 48 (02) 315-320
• 10 Emil S, Sévigny M, Montpetit K. , et al. Success and duration of dynamic bracing for pectus carinatum: A four-year prospective study. J Pediatr Surg 2017; 52 (01) 124-129
• 11 Ateş O, Karakuş OZ, Hakgüder G, Olguner M, Akgür FM. Pectus carinatum: the effects of orthotic bracing on pulmonary function and gradual compression on patient compliance. Eur J Cardiothorac Surg 2013; 44 (03) e228-e232
• 12 Lopez M, Patoir A, Varlet F. , et al. Preliminary study of efficacy of dynamic compression system in the correction of typical pectus carinatum. Eur J Cardiothorac Surg 2013; 44 (05) e316-e319
• 13 Frey AS, Garcia VF, Brown RL. , et al. Nonoperative management of pectus carinatum. J Pediatr Surg 2006; 41 (01) 40-45 , discussion 40–45
• 14 Colozza S, Bütter A. Bracing in pediatric patients with pectus carinatum is effective and improves quality of life. J Pediatr Surg 2013; 48 (05) 1055-1059
• 15 Moon DH, Kang MK, Lee HS, Lee S. Long-term results of compressive brace therapy for pectus carinatum. Thorac Cardiovasc Surg 2018; 67 (01) 67-72
• 16 Kravarusic D, Dicken BJ, Dewar R. , et al. The Calgary protocol for bracing of pectus carinatum: a preliminary report. J Pediatr Surg 2006; 41 (05) 923-926
• 17 Lee RT, Moorman S, Schneider M, Sigalet DL. Bracing is an effective therapy for pectus carinatum: interim results. J Pediatr Surg 2013; 48 (01) 184-190
• 18 Jung J, Chung SH, Cho JK, Park S-J, Choi H, Lee S. Brace compression for treatment of pectus carinatum. Korean J Thorac Cardiovasc Surg 2012; 45 (06) 396-400
• 19 Port E, Hebal F, Hunter CJ, Malas B, Reynolds M. Measuring the impact of brace intervention on pediatric pectus carinatum using white light scanning. J Pediatr Surg 2018; 53 (12) 2491-2494
• 20 Szafer D, Taylor JS, Pei A. , et al. A simplified method for three-dimensional optical imaging and measurement of patients with chest wall deformities. J Laparoendosc Adv Surg Tech A 2018; 29 (02) 267-271
• 21 Fraser S, Harling L, Patel AJ, Richards T, Hunt I. External compressive bracing with initial reduction of pectus carinatum: Compliance is the key. Submitted. Sept 2018