Dynamic bracing of pectus carinatum: a quantitative analysis

See you at the 49th Annual Meeting of the Canadian Association of Paediatric Surgeons, CAPS in Banff, Alberta, October 5-7, 2017 at the Fairmont Banff Springs.

Purpose:
Pectus carinatum (PC) presents as an overgrowth of the costal cartilages resulting in a protrusion of the sternum. Primary treatment of PC is performed with an external brace that compresses the protrusion. Patients are ‘prescribed’ a brace tightening force; however, no visual guides exist to display this force magnitude. The purpose of this study was to determine the repeatability of patients in applying their prescribed force over time, and to determine whether the protrusion stiffness influences the participant-applied forces and the protrusion correction rate.
Methods
Eleven male participants were recruited (n=11, 10–18 years) at the time of brace fitting (Braceworks, Calgary, Canada) who met the inclusion criteria of symmetrical PC and no connective tissue disorders.

Participants were evaluated on three visits: fitting, one month post-fitting, and two months post-fitting. Differences between prescribed force and participant-applied force were evaluated with a paired t-test. Relationships of participant-applied force and correction rate with protrusion stiffness were assessed with a general linear mixed model (α=0.05). Research ethics approval was obtained (University of Calgary REB14-1759).

Results
Majority of cases (72%) had a significantly different applied force (p≤0.05) from their prescribed force (1.94±0.68 lbs). Protrusion stiffness had no relationship with participant-applied force (p=0.11) or correction rate (p=0.37).
Conclusion
Participants did not follow their prescribed force. Magnitudes of these differences require further investigation to determine clinical significance. Participant forces and correction rate were not influenced by protrusion stiffness. Additional participants are required for statistical power. Other factors may influence these variables such as patient compliance, and require further study.

Dynamic bracing of pectus carinatum: a quantitative analysis, Tomasz Bugajski, Kartikeya Murari, Steven Lopushinsky, Marc Schneider, Jacob Reichbart, Janet Ronsky. Abstract 19, Canadian Association Of Paediatric Surgeons CAPS 49th Annual Meeting Banff, Alberta Canada, October 5-7, 2017

Also see
The Dynamic Compression Brace for Pectus Carinatum: Intermediate Results in 286 Patients, de Beer SA, Gritter M, de Jong JR, van Heurn ELW. Ann Thorac Surg. 2017 Jun;103(6):1742-1749. doi: 10.1016/j.athoracsur.2016.12.019. Epub 2017 Mar 6.

A less intensive bracing protocol for pectus carinatum, Wahba G, Nasr A, Bettolli M. J Pediatr Surg. 2017 Nov;52(11):1795-1799. doi: 10.1016/j.jpedsurg.2017.01.057. Epub 2017 Jan 31.

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