Orthotic Brace Corrects Chest Deformities
Orthotic Brace Corrects Chest Deformities
October 2005
JANE SALODOF MACNEIL (Southwest Bureau)
Rheumatology News
Elsevier Inc
PHOENIX Û Custom fitting an orthotic brace can be an effective alternative to corrective surgery in adolescents who develop pectus carinatum, Ala Stanford Frey, M.D., reported at the annual meeting of the American Pediatric Surgical Association.
Dr. Frey's study reviewed charts of 100 patients diagnosed with a protruding sternum from 1997 to 2004. As is typical for the chest deformity, four out of five were boys. Physicians had referred 29 patients for orthotic bracing: 24 boys and 5 girls. The average age of treatment onset was 12.4 years.
Each custom-fitted design had anterior and posterior polymer compression plates, aluminum struts, and adjustable straps. Patients were instructed to wear the brace 14Ò16 hours per day for a minimum of 2 years or until linear growth was complete. The brace was tightened every 2Ò4 weeks initially, and then every 3Ò6 months.
Twenty-six of 29 youngsters fitted at Cincinnati Children's Hospital Medical Center wore the brace for an average of 2.5 years, said Dr. Frey of the hospital's division of pediatric general surgery and thoracic surgery.
All 26 had positive outcomes, with some patients showing improvement as early as 6 weeks and most by 1 year. None suffered any complications, according to Dr. Frey and her coauthors from the hospital and the University of Cincinnati.
Pre- and posttreatment photographs, along with patient accounts of changes in chest contour, were the main outcome measures. ÏPatients could tell us by looking in the mirror that they felt better, and that was the most accurate measure of improvement,Ó Dr. Frey said.
Three of the adolescents who did not stick with the brace were referred to surgery. Their lack of compliance was attributed to behavioral problems, developmental delay, and concerns about breast development.
Dr. Frey said the 71 patients not referred for orthotic bracing included 57 with mild defects who did not have any intervention. The remaining 14 were surgically corrected, bringing the total number of operations to 17. Most procedures were performed in patients before the brace became an option, she said.
The longest follow-up has been 7 years. Although some recurrences were recorded, she said they were resolved with resumed use of the brace. None of the brace wearers required surgical intervention.
In response to an audience question, Dr. Frey estimated that the brace costs $700, compared with $20,000 for an operation.
ÏNinety percent of our patients in a teenaged population were compliant,Ó she said, addressing a key issue for the audience.
Dr. Frey noted that the brace works more readily in younger adolescents, but she advocated its use in 16- to 17-year-olds as well. ÏYou don't lose anything by giving them a trial with the brace.Ó
A 14-year-old male patient with an asymmetric chondrogladiolar pectus carinatum is shown before bracing (far left) and after 1 year of bracing. Photos courtesy Dr. Richard G. Azizkhan
© 2005 Elsevier Inc. All rights reserved.
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