WOFAPS 2025 8th World Congress of Pediatric Surgery

Zafer Alparslan ¹, Burak Kızılca ¹, Mustafa Yüksel ²

¹ Marmara University School of Medicine
² Demiroglu Bilim University School of Medicine, Thoracic Surgery Department

Purpose
Pectus carinatum (PC) is the second most prevalent chest wall deformity. Orthosis treatment has gained popularity, demonstrating effectiveness with patient compliance. However, research on bracing remains limited, and key factors influencing success require further investigation. This study presents our clinical findings on external bracing and proposes an indicator to predict treatment success.

Methods
This study included all patients with PC who presented our private pectus clinic in Istanbul between 2019 and May 2024. Demographics and features of deformity including asymmetry and initial force of correction (1FOC) were obtained after history taking and physical examination. Custom-made external bracing orthoses were provided to each patient who opted for treatment. In the first follow-up, force of correction was remeasured (2FOC). Descriptive statistics were used, and correlation analyses were conducted to identify factors associated with deformity characteristics and success

Results
Majority of our patients (n=1141) was male (n=934, 81.9%) with the mean age of 13.52 ± 5.61, 90% of participants were below 18. Mean 1FOC at initial presentation was 6.64 ± 3.09 kg, correlating with age (r=0.51). Family history in first-degree relatives was noted in 13.3% of patients. Among the 404 patients who started and adhered treatment, 208 patients achieved successful outcomes. Age and 1FOC were not different between successful and unsuccessful groups. Notably, successful patients exhibited strong initial response to orthotic treatment in the first follow-up, 2FOC/1FOC ratio getting below 50% (n=175, 84.1%).

Conclusion
Our findings indicate that orthotic success in PC patients is not dependent on quantitative deformity severity or age at presentation but rather on the initial response at the first follow-up. Therefore, we recommend offering external bracing to all motivated patients, regardless of deformity severity or age. Quantitative assessment during the first follow-up may provide valuable guidance for treatment planning.