ABSTRACT
Treatment of pectus carinatum and pectus excavatum with dynamic chest compressor (DCC) orthoses have been reported by Haje and others. The goal of this study was to demonstrate that overcorrection during orthotic treatment of children and adolescents with pectus deformities can occur and requires medical attention. Of 3,028 children and adolescents with pectus deformities, observed between 1977 and October 2005, 1,824 were prescribed treatment with DCC orthoses and, after a few months of treatment, some overcorrection was noted in 30 patients. Of the patients who received orthoses, 738 had a minimum follow-up of 1 year and 17 of these, 2 with pectus excavatum and 15 with pectus carinatum, presented overcorrection and were studied. The dynamic remodeling method (DCC orthoses + exercises) was applied. The procedures, adopted according to each patient's needs, were: decreasing the time of orthosis wear and/or the tightening of the screws, introducing a second orthosis, and improving the prescribed exercises and/or encouraging the patient to perform them more intensively. The therapy was successful in all patients, and the result was maintained in one case of pectus excavatum followed up until adulthood. It was concluded that overcorrection during DCC orthosis wear can occur and that careful medical follow-up is necessary if this complication is to be successfully reversed.
Subject(s)
Funnel Chest/therapy , Orthotic Devices/adverse effects , Adolescent , Child , Female , Humans , MaleABSTRACT
BACKGROUND: Radiologic reports of "normal" chest are not uncommon when there clearly are irregularities of sternal ossification and maturation. Analysis of imaging studies of sternal deformities for growth disturbances is not common in the literature and is addressed in this manuscript. OBJECTIVE: To determine the influence of sternal growth on development of pectus deformities and correlate imaging studies with clinical aspects of different types of these deformities. MATERIAL AND METHODS: One hundred forty-one children and adolescents with pectus deformities were evaluated. Sternal growth was estimated through the development of radiographic indices that were available for 57 patients with pectus deformities and for 71 controls. Magnetic resonance imaging of the sternum was performed in two patients to correlate with radiographic information. RESULTS: Radiographic indices of the sternum suggested growth disturbances in three basic types of pectus carinatum deformities: superior, inferior and lateral, and in the localized type of pectus excavatum. CONCLUSION: Sternal growth seems to have an important influence on the development of carinatum superior; partial influence on carinatum inferior, carinatum lateral, and excavatum localized; and no influence on excavatum wide pectus deformities. The endochondral growth of the sternum and costal arches is an important concept that aids in the interpretation of imaging studies and the orthopedic approach to management of these deformities in children and adolescents.
Subject(s)
Funnel Chest/diagnosis , Magnetic Resonance Imaging , Radiography, Thoracic , Sternum/growth & development , Adolescent , Adult , Child , Child, Preschool , Funnel Chest/etiology , Humans , Infant , Sternum/anatomy & histology , Sternum/diagnostic imagingABSTRACT
A boy underwent cardiac surgery when he was 27 months old; prior to that his anterior chest wall had been normal. He later developed a progressive pectus carinatum deformity. Thoracic surgeons are cautioned to be mindful of the sternal and costal growth plates in any surgical approach to intrathoracic structures. Special care is needed when such deformities are corrected in children and adolescents.
Subject(s)
Postoperative Complications/etiology , Sternum/pathology , Thoracotomy , Child , Humans , Male , Salter-Harris Fractures , Sternum/growth & development , Sternum/surgery , Sutures/adverse effectsABSTRACT
Fifty-five children and adolescents with different types of pectus deformities and a minimum follow-up of 1 year were assessed to determine the effectiveness of nonoperative treatment with a dynamic chest compressor orthosis. Thirty-seven patients were treated and compared with 18 untreated patients. The treated patients had a better outcome. Reshaping of the contour of the chest wall was observed in 21 patients with inferior and lateral types of pectus carinatum. The dynamic chest compressor has minimal morbidity and is a valuable treatment option of pectus deformities in the growing period.
