Spinal deformities and other orthopedic disorders in children with pectus carinatum

BACKGROUND: Owing to its clear clinical manifestation, pectus carinatum is often the reason for the initial visit to the doctor of children with several concomitant orthopedic abnormalities. AIM: To identify concomitant orthopedic disorders in children with pectus carinatum and assess their frequency, clinical manifestations, and relationships with various modifiable and non-modifiable factors. MATERIALS AND METHODS: This observational, single-center, cross-sectional study included 147 patients aged 5–17 years with pectus carinatum. Orthopedic examination and radiography of the spine were performed. Categorical values were described by reporting absolute values and percentages in the sample and quantitatively using arithmetic averages and standard deviations. The Student’s T-test and Chi-square coefficient were used for assessing the relationship (p 0.05). RESULTS: In 3/147 (2.0%) children, pectus carinatum was a symptom of genetically confirmed Marfan syndrome. Among 147 children with pectus carinatum, 56 (38.1%) complained of back pain, 125 (85.0%) had a mobile plano-valgus foot, and 108 (73.5%) had postural disorders. Scheuermann disease was detected in 22 (15.0%) children and signs of spinal osteochondrosis in 57 (38.8%). Back pain was associated with sclerosis/usuration of the vertebral end plates. Children who regularly engaged in sports involving forceful load on the back muscles complained of pain less often, regardless of the degree of spine deformity. CONCLUSIONS: Mobile flat foot, sagittal component of posture disorders, and spinal osteochondrosis are common in children with pectus carinatum. Thus, children with keel chest deformity should undergo orthopedic examination and spinal X-ray in a standing position. Because of the high incidence of back pain and its association with insufficient muscular frame development, children with pectus carinatum are recommended to regularly engage in physical therapy and/or sports associated with loads on the back muscles.