Kids Health Info

Chest Orthosis - Pectus Carinatum

  • What is pectus carinatum?

    Pectus carinatum (PC) is a chest wall deformity where there is overgrowth of the cartilage between the ribs and the sternum (also known as the breastbone), causing the sternum to stick out. Although the shape of the chest wall is distorted, it does not usually affect the internal organs.

    PC is most common in adolescent males. Four times as many males as females have PC. It becomes more noticeable during puberty when the body goes through a growth spurt. PC continues until the bones stop growing. This is known as skeletal maturity and usually occurs at around 18 years of age.

    PC does not cause any functional problems but it could impact on your child's social life or be a cause of concern or anxiety, especially when exposing the chest protrusion at the beach, pool or changing room.

    Treatment

    PC is treated using a chest orthosis, also known as a brace. The orthosis/brace helps to correct the shape of the chest wall by compressing, or squeezing, the overgrown ribs or breastbone back to a 'normal' position. The orthosis is worn until satisfactory results are achieved and the chest wall can stay in position by itself.

    Wearing the orthosis

     There are two main phases of wear: corrective and maintenance.

    1. Corrective phase: The first three to six months during which the orthosis is worn 23 hours a day.
    2. Maintenance phase: When the chest overgrowth has flattened enough, the orthosis is worn for eight hours each night. During this phase, patients continue to monitor their chests to make sure there is no relapse. This phase usually lasts another three to six months.
    • The orthosis should not be worn during high intensity activities such as sport.
    • Your orthotist will show your child how to wear the orthosis correctly and adjust it appropriately.

    Things to look for

    • When the orthosis is removed, check the skin to make sure there is no rubbing or skin breakdown on the protruding chest.
    • Mild redness over the protruding chest is normal and to be expected.
    • Feeling slight pressure while wearing the orthosis is normal.  However, if your child feels any pain while wearing the orthosis, contact the orthotist for a review.

    Hygiene and care at home 

    • Your child's chest will become sweaty under the orthosis. Your child must wash the skin daily beneath the front and back pads with a loofah (rough sponge). Monitor the skin's condition to avoid sores or rashes. Contact the department for a review appointment if necessary.
    • Wearing a singlet or t-shirt under the brace will stop the skin from rubbing and becoming damaged or sore.

    Follow up

    Treatment is monitored by frequent orthotic reviews or follow ups and with the use of 3D photography. The chest orthosis is reviewed one week after fitting and then every four weeks after that. Your orthotist will arrange reviews in orthotics and photography to monitor the progress of your child's chest and will adjust the orthosis as required. 

    Contact your orthotist if you have any questions or concerns regarding your child's treatment with a chest orthosis.

    Chest orthosis process

    • A cast is taken for the chest orthosis (brace).
    • The first fit occurs three to four weeks after the cast is taken. Initial 2D and 3D photos are taken of the fitted cast.
    • A review takes place one week after the fitting. This will be the initial review to ensure there are no issues or problems.
    • Another review takes place three weeks later with the Orthotic Department as well as the referring consultant. The appointment with the consultant is to be organised independently.
    • Reviews are ongoing every four weeks in the Prosthetic and Orthotic Department.
    • 3D photos should be taken every three months from the initial fitting date. Photos can be taken Tuesdays and Thursdays.
    • Reviews should also be conducted every three months with the referring consultant (independently organised).

    Chest Orthosis guidelines

    • Wear the brace for 23 hours a day during the corrective phase, which lasts for approximately three to six months, or until the protrusion disappears and the patient is happy with their chest shape.
    • Start the maintenance phase (wear the brace eight to 10 hours a day, usually at night). If the protrusion reappears during the maintenance phase, your child will need to restart the corrective phase and wear the brace for 23 hours a day.
    • Continue the maintenance phase for three months and then remove the brace. Photos will be taken at the end of this phase.
    • Further 3D photos should be taken three months after the removal of the brace to ensure the protrusion has remained constant.
    • Patient is to have an orthotic review and 3D photographs every six months following the removal of the brace.

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    Developed by the RCH Dept of Prosthetics and Orthotics  First published: October 2010

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Disclaimer 
This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.