Pectus carinatum, overview and results of orthotic bracing therapy

Abstract

Pectus carinatum may occur alone or together with other congenital disorders or even syndromes, causing the sternum to protrude. Patients with pectus carinatum are generally asymptomatic however the deformity may induce lung and cardiac dysfunction. Pectus deformities can also have an impact on a child's self-image and self-confidence. In this paper we give an overview of the pathophysiology, the epidemiology, clinical presentation, diagnosis and differential diagnosis as well as treatment and management of this congenital condition and present our results applying orthotic bracing in 65 children including a survey from the patients and /or the parents. Our results are very promising with improvement of the quality of life for the patients and probably prevention of orthopedic problems such as scoliosis in the future. Key words: pectus carinatum, orthotic brace, childrenКилевидная деформация грудной клетки (КДГК) является самостоятельной нозологией или встречается в сочетании с другими врожденными нарушениями и синдромами. У пациентов с КДГК, как правило, заболева-ние протекает бессимптомно, однако могут отмечаться нарушения со стороны легких и сердца. КДГК также оказывает влияние на самооценку ребенка. В этой статье мы даем обзор патофизиологии, эпидемиологии, клинических проявлений, а также лечение и тактику ведения этого врожденного порока. В исследовании пред-ставлены результаты применения ортопедической компрессионной терапии у 65 детей, в том числе опреде-ление качества жизни пациентов и/или их родителей. Наши результаты являются весьма многообещающими, поскольку проведенное лечение улучшает качество жизни пациентов с КДГК и, возможно, обеспечивает про-филактику ортопедических проблем, в том числе и сколиоза в будущем.Ключевые слова: килевидная деформация грудной клетки, ортопедическая компрессионная терапия, дети B ack as far as the 4 th century BC Hippocrates described this chest deformity as a «sharply pointed chest» in patients that demonstrated difficulty of breathing.» The term pectus carinatum or keel shaped breast or pigeon breast is used to describe a spectrum of protrusion abnormalities of the anterior chest wall. Although many affected patients have no or little complaints most of the patients especially adolescents indicate concerns about body image with low self-esteem and subsequently a decreased quality of life [1]. These cosmetic concerns have to be considered significant factors for correction of this congenital malformation.Pectus carinatum deformity was thought to be asymptomatic until recently. However new studies have proven that cardiopulmonary function can be impaired throughout the life of these children. Some patients develop a rigid chest wall, in which the AP diameter is almost fixed in full inspiration making respiratory efforts less efficient. Vital capacity can be reduced whereas residual air is increased resulting in alveolar hypoventilation with arterial hypoxemia and the development of cor pulmonale. The lungs lose compliance, incidence of emphysema and frequency of infecti...