Overcorrection during treatment of pectus deformities with DCC orthoses: experience in 17 cases

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Abstract

Treatment of pectus carinatum and pectus excavatum with dynamic chest compressor (DCC) orthoses have been reported by Haje and others. The goal of this study was to demonstrate that overcorrection during orthotic treatment of children and adolescents with pectus deformities can occur and requires medical attention. Of 3,028 children and adolescents with pectus deformities, observed between 1977 and October 2005, 1,824 were prescribed treatment with DCC orthoses and, after a few months of treatment, some overcorrection was noted in 30 patients. Of the patients who received orthoses, 738 had a minimum follow-up of 1 year and 17 of these, 2 with pectus excavatum and 15 with pectus carinatum, presented overcorrection and were studied. The dynamic remodeling method (DCC orthoses + exercises) was applied. The procedures, adopted according to each patient's needs, were: decreasing the time of orthosis wear and/or the tightening of the screws, introducing a second orthosis, and improving the prescribed exercises and/or encouraging the patient to perform them more intensively. The therapy was successful in all patients, and the result was maintained in one case of pectus excavatum followed up until adulthood. It was concluded that overcorrection during DCC orthosis wear can occur and that careful medical follow-up is necessary if this complication is to be successfully reversed.

Le traitement du pectus carinatum et du pectus excavatum avec une orthèse dynamique (DCC) a été rapporté par Haje et coll. Le but de cette étude est de montrer que l'hypercorrection est possible. Sur 3028 enfants et adolescents atteints de déformation pectorale, observés entre 1977 et 2005, 1824 ont eu un traitement par orthèse DCC et une hypercorrection a été noté chez 30 patients. Parmi les patients traités 738 ont un suivi minimum d'un an et 17 d'entre eux (2 pectus excavatum et 15 pectus carinatum), ont une hypercorrection. Le traitement ( orthèse + exercices), adapté à chaque patient était: diminution du temps de port de l'orthèse et/ou resserrage des vis, utilisation d'une seconde orthèse et stimulation du patient pour augmenter l'intensité des exercices. Des améliorations étaient obtenues dans tous les cas et, dans un cas de pectus excavatum, maintenues jusqu'à l'âge adulte. Il est conclu que l'hypercorrection peut survenir durant le port de l'orthèse DCC et que pour la contrôler une surveillance médicale soigneuse doit être faite.

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