Pectus Carinatum is an outward protrusion of the chest wall and sternum. This protrusion can be either symmetric or asymmetric. The cause is unknown, but pectus may run in families. Pectus Carinatum has been termed pigeon chest, although this term is currently discouraged. Surgical removal of the front rib cartilages and cutting of the sternum was previously the preferred approach, but is now reserved for failure of bracing. Success of bracing is greater than 90% in patients compliant with the required regimen.
The first report of use of a pectus brace was in 1993. In 2000, Dr. J.Craig Egan described objective, radiograph-proven success in treatment of pectus carinatum using an orthotic brace. This was followed by the first published series of compressive orthotic bracing for pectus carinatum by the surgeons at Cincinnati Children’s Hospital. Operative repair of pectus carinatum is now reserved only for patients that fail orthotic bracing.
|Before Pectus Brace||After Pectus Brace|
The brace is worn 14 hours a day for 2 years, or until full height is achieved. The ideal age for bracing is probably age 11 or 12 years, while the cartilage is still pliable, but success has been achieved in patient from 6 to 16 years of age. Most patients remove the brace to sleep and wear it all day over a thin t-shirt. Most patients show improvement within the first year. Not much additional improvement is seen after 18 months.
Pediatric Surgeons of Phoenix works with Gina Retallack, CO at Hanger Orthotics to fit children with severe pectus carinatum. We use the protocol described by Frey, Garcia, Brown et. al at Cincinnati Children’s Hospital Medical Center.
3 photos showing results of bracing. Photos taken June 2010, October 2010, Dec 2010
Pectus Carinatum Brace being worn over a thin t-shirt
Pectus Bracing is also an option for girls. The following shows a custom brace and intermediate results of bracing.
Frey, Garcia, Brown et. al “Nonoperative management of pectus carinatum”
Journal of Pediatric Surgery 41: 40-45, 2006
Egan JC, Dubois JJ, Morph M, Samples TL, Lindell B “Compressive orthotics in the treatment of pectus carinatum: A preliminary report with an objective radiographic marker”
Journal of Pediatric Surgery 35(8):1183-86, 2000
Mielke CH, Winter RB. Int Orthop. 1993 Dec;17(6):350-2. Pectus carinatum successfully treated with bracing. A case report.