A Comparative Study on Short-Term Effects of Compression Orthosis and Exercises in the Treatment of Pectus Carinatum: A Randomized Controlled Pilot Feasibility Trial
Introduction Pectus carinatum (PC) is a congenital chest wall deformity which is characterized by the protrusion of the sternum and costal cartilages. Although orthotic and exercise therapies are commonly offered by physicians for PC treatment, there is a lack of evidence on the benefits of exercises and how long the orthosis should be worn. The aim of this study is to investigate the effects and feasibility of custom-made compression orthosis and exercises in the treatment of PC.
Materials and Methods Patients with PC aged 7 to 17 years old were randomized into three groups: compression orthosis 23 hours, compression orthosis 8 hours, and control group. All groups received exercises for 1 hour a day for 3 weeks. Additionally, compression orthosis 23 hours group wore the orthosis for 23 hours a day, while compression orthosis 8 hours group wore the orthosis for 8 hours a day. PC protrusion, pressure of correction, thorax lateral and anteroposterior parameters, external chest wall measurements, and Nuss Questionnaire were evaluated before and after the treatment. Also, adverse effects, retention, and compliance were assessed. Feasibility was evaluated by calculating the percentages of recruitment, retention, and safety.
Results The compression orthosis 23 hours group showed greater improvements than the other groups. After treatment, all groups showed significant changes in protrusion, pressure of correction, and external chest wall measurements. Adverse events occurred with similar frequency across groups. Retention percentages did not differ among groups.
Conclusion Compression orthosis use for 23 hours can be recommended rather than its use for 8 hours because 23 hours of orthosis use has better correction and similar adverse effects.
Eingereicht: 17. November 2019
Angenommen: 06. Januar 2020
Artikel online veröffentlicht:
08. März 2020
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Frey AS, Garcia VF, Brown RL. et al. Nonoperative management of pectus carinatum. J Pediatr Surg 2006; 41 (01) 40-45
- 2 Ewert F, Syed J, Wagner S, Besendoerfer M, Carbon RT, Schulz-Drost S. Does an external chest wall measurement correlate with a CT-based measurement in patients with chest wall deformities?. J Pediatr Surg 2017; 52 (10) 1583-1590
- 3 Fokin AA, Steuerwald NM, Ahrens WA, Allen KE. Anatomical, histologic, and genetic characteristics of congenital chest wall deformities. Semin. Thorac. Cardiovasc. Surg. 2009; 21 (01) 44-57
- 4 Martinez-Ferro M, Bellia Munzon G, Fraire C. et al. Non-surgical treatment of pectus carinatum with the FMF® Dynamic Compressor System. J Vis Surg 2016; 2 (03) 57
- 5 American Pediatric Surgical Association. Pectus carinatum guideline. APSA guideline; 2012. Accessed March 11, 2019 at: https://www.eapsa.org/apsa/media/Documents/Pectus_Carinatum_Guideline_080812.pdf
- 6 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
- 7 Martinez-Ferro M, Fraire C, Bernard S. Dynamic compression system for the correction of pectus carinatum. Semin Pediatr Surg 2008; 17 (03) 194-200
- 8 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
- 9 Banever GT, Konefal Jr SH, Gettens K, Moriarty KP. Nonoperative correction of pectus carinatum with orthotic bracing. J Laparoendosc Adv Surg Tech A 2006; 16 (02) 164-167
- 10 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
- 11 Cheung S. Exercise therapy in the correction of pectus excavatum. J Pediatr Respir Crit Care 2005; 1: 10-13
- 12 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
- 13 Kang D-Y, Jung J, Chung S, Cho J, Lee S. Factors affecting patient compliance with compressive brace therapy for pectus carinatum. Interact Cardiovasc Thorac Surg 2014; 19 (06) 900-903
- 14 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
- 15 Hacquebord JH, Leopold SS. In brief: the Risser classification: a classic tool for the clinician treating adolescent idiopathic scoliosis. Clin Orthop Relat Res 2012; 470 (08) 2335-2338
- 16 Bahadir AT, Kuru P, Afacan C, Ermerak NO, Bostanci K, Yuksel M. Validity and reliability of the Turkish version of the Nuss questionnaire modified for adults. Korean J Thorac Cardiovasc Surg 2015; 48 (02) 112-119
- 17 Guo Y-H, Kuan T-S, Chen K-L. et al. Comparison between steroid and 2 different sites of botulinum toxin injection in the treatment of lateral epicondylalgia: a randomized, double-blind, active drug-controlled pilot study. Arch Phys Med Rehabil 2017; 98 (01) 36-42
- 18 Fritz CO, Morris PE, Richler JJ. Effect size estimates: current use, calculations, and interpretation. J Exp Psychol Gen 2012; 141 (01) 2-18
- 19 Saxena S, Rao BK, Senthil KD. Short-term balance training with computer-based feedback in children with cerebral palsy: A feasibility and pilot randomized trial. Dev Neurorehabil 2017; 20 (03) 115-120
- 20 Thaker S, Anderson M, Fezio J, Rader C, Misra MV. Pectus carinatum: factors that contribute to success and failure of nonoperative treatment. Conn Med 2017; 81 (04) 203-208
- 21 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
- 22 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
- 23 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