Dynamic Compression System Bracing as a Treatment Option for Chondromanubrial Pectus Carinatum

Abstract

Introduction

Chondromanubrial pectus carinatum (PC) is a rare type of pectus deformity in which there is protrusion of the manubrium and superior costal cartilage. Studies have shown that orthotic bracing is successful in correcting chondrogladiolar PC, but surgery has been the primary treatment for the chondromanubrial subtype. Due to the rarity of this type of PC, we aimed to describe our experience and outcomes with the dynamic compression system (DCS) bracing in these patients.

Methods

This is retrospective single center review of all patients with chondromanubrial PC treated with DCS from 2011 to 2021. Data collected included demographics, PC type and location, brace initiation date, pressure of initial correction (PIC), exercise activity, frequency of brace use, and final treatment results. Data are presented with medians with interquartile ranges (IQRs) and frequencies with percentages.

Results

11 patients had chondromanubrial PC treated with the brace system. There was an equal distribution in gender, with a median age at brace placement of 13 years (IQR 12, 15). The median change in PIC from the first clinic visit to the last was 2.6 psi (IQR 1.6, 3.8). Most of the cohort (80%) exercised and 50% achieved retainer stage at a median time of 121 days (IQR 91, 238). Four patients maintained correction at the last clinic visit, with the remaining achieving partial improvement of the PC deformity.

Conclusion

Dynamic compression system can be an effective initial approach in managing patients with chondromanubrial PC. Although some patients did not achieve total correction, there was an improvement in the chest wall deformity in all cases.