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is a resource devoted entirely to the non-surgical treatment of Pectus Carinatum
Pectus Carinatum
Pectus Carinatum (PC) or so-called ‘Pigeon Chest’ is one of a spectrum of anterior chest wall developmental anomalies involving an idiopathic overgrowth of the costal cartilages resulting in protrusion defect of the sternum.
The cause of PC is unknown. However, it may be genetically linked with recurrence in families. PC may occur as a solitary abnormality or in association with other genetic disorders or syndromes. The overall prevalence of PC is 0.06 percent and it is more common in boys with a male to female ratio of 4:1. Deformity is usually present from early childhood, but it’s becoming much more prominent in adolescents, during the phase of linear growth. There is a strong correlation between teenage growth and worsening of Pectus deformities. The majority of patients are completely asymptomatic. Symptoms are frequently related to some other associated anomaly (e.g., Scoliosis, congenital heart disease or pulmonary involvement).
The classical management of PC has been primarily surgical involving some modification of the Ravitch technique, a re-section of the deformed costal cartilages along with sternal osteotomy. A rather invasive, not to mention painful, surgical procedure with relatively good results yet long-term worsening of the cosmetic appearance and decreased chest wall compliance over time.
Non-surgical treatments of PC including compressive orthoses were first proposed by Drs. Haje and Raymundo of Brazil in 1979. Compressive orthoses are designed to place the external forces on the point of the most prominent sternal protrusion of the deformity to provide continued pressure to stimulate bone and cartilages remodeling.
Dr. Richard Dewar of the Alberta Children’s Hospital collaborated with Marc Schneider, BPE, Certified Orthotist in 1992 to adapt the non-surgical treatment pioneered by Drs. Haje and Raymundo to Calgary, Preliminary Results of Orthotic Treatment of Pectus Deformities in Children and Adolescents, (Haje, SA and Bowen, JR; Journal of Pediatric Orthopaedics, 12:795-780).
Marc Schneider has since developed a lightweight, low-profile, dynamic brace incorporating self-adjusting ratcheting buckles that allow the patient to control pressure. The brace has greatly improved the patient adoption and compliance of the intervention. Mr. Schneider works closely with the Calgary protocol team. Braceworks supplies the Pectus Brace internationally. More info
The subsequent work of Donald Nuss on Pectus Excavatum demonstrating the plasticity of the chest wall has led to current research, Bracing for Pectus Carinatum—The Calgary Protocol, (Kravarusic, D., Dewar, R., Harder, J., Schneider, M., Sigalet, D.), presented at Surgeons Day in Calgary, Alberta, June 2005 to establish similar remodeling for PC in response to chronic pressure using an orthoses with cosmetically superior, non-operative results. Read the summary of The Calgary Protocol for Bracing of Pectus Carinatum: A Preliminary Report, (Dragan Kravarusic, Bryan J. Dicken, Richard Dewar, James Harder, Philippe Poncet, Mark Schneider and David L. Sigalet). Findings were presented at the 37th Annual Meeting of the Canadian Association of Paediatric Surgeons, Quebec Canada, September 2005 and published in the Journal of Pediatric Surgery, Volume 41, Issue 5, May 2006, Pages 923-926.