- congenital or early acquired curvature of the sternum and ribs articulating with it. Chest deformities in children are manifested by a visible cosmetic defect, disorders of the respiratory and cardiovascular systems (shortness of breath, frequent respiratory diseases, fatigue). Diagnosis of chest deformity in children involves thoracometry, radiography (CT, MRI) of the chest, spine, sternum, ribs; functional studies (RF, EchoCG, ECG). Treatment of chest deformity in children can be conservative (exercise therapy, massage, wearing an external corset) or surgical.
General information
Chest deformities in children - a pathological change in the shape, volume, size of the chest, leading to a decrease in the sterno-vertebral distance and a violation of the position of internal organs. Chest deformities occur in 14% of the population; while in children (mainly in boys) congenital anomalies are diagnosed with a frequency of 0.6-2.3%. Chest deformities in children are a cosmetic defect, can cause functional problems in breathing and cardiac activity, and cause psychological discomfort to the child. These circumstances adversely affect the harmonious development of children and their social adaptation. The problem of chest deformities in children is relevant for thoracic surgery, pediatric traumatology and orthopedics, pediatric cardiology, and child psychology.
Causes of chest deformities in children
According to the time of development and the influencing causal factors, congenital and acquired deformities of the chest in children are distinguished. Congenital deformities may be due to genetic causes or result from a violation of the development of the skeleton (sternum, ribs, spine, shoulder blades) in the prenatal period.
Hereditary deformities of the chest in certain families occur in children in 20-65% of cases. Currently, many syndromes are known, one of the components of which are defects of the sternocostal complex. The most common among them is Marfan's syndrome, characterized by an asthenic physique, arachnodactyly, funnel-shaped and keeled chest deformity, exfoliating aortic aneurysm, subluxation and dislocation of the lenses, biochemical changes in the metabolism of glycosaminoglycans and collagen. The formation of hereditary chest deformities in children is based on cartilage and connective tissue dysplasia, which develops as a result of various enzymatic disorders.
The causes of non-hereditary (sporadic forms) defects of the anterior chest wall are unknown. Any teratogenic factors affecting the developing fetus can lead to this. Most often, congenital deformities of the chest in children are caused by uneven growth of the sternum and costal cartilages, pathology of the diaphragm (short muscle fibers can pull the sternum inward), pathology of the development of cartilage and connective tissue.
Acquired deformities of the chest in children, as a rule, develop as a result of past diseases of the musculoskeletal system - rickets, tuberculosis, scoliosis, systemic diseases, tumors of the ribs (chondromas, osteomas, exostoses), osteomyelitis of the ribs, etc. In some cases, acquired deformity of the chest cells are caused by purulent-inflammatory diseases of the soft tissues of the chest wall (phlegmon) and pleura (chronic empyema), mediastinal tumors (teratoma, neurofibromatosis, etc.), injuries and burns of the chest, emphysema. In addition, chest deformities in children may be the result of unsatisfactory results of thoracoplasty, median sternotomy for congenital heart defects.
Classification of chest deformities in children
According to the type of chest deformity in children, they can be symmetrical and asymmetric (right-sided, left-sided). Among congenital deformities of the chest in children in pediatrics, funnel chest (pectus excavatum) and keeled chest (pectus carinatum) are more common. Rare congenital deformities of the chest (about 2%) include Poland's syndrome, cleft sternum, etc.
Funnel chest deformity in children ("cobbler's chest") is about 85-90% of congenital malformations of the chest wall. Its characteristic feature is the retraction of the sternum and anterior ribs, which is different in shape and depth, accompanied by a decrease in the volume of the chest cavity, displacement and rotation of the heart, and curvature of the spine.
The severity of funnel chest deformity in children can be 3 degrees:
- I - depression of the sternum up to 2 cm; the heart is not displaced;
- II - depression of the sternum 2-4 cm; displacement of the heart less than 3 cm;
- III - depression of the sternum more than 4 cm; displacement of the heart more than 3 cm.
Keeled deformity of the chest ("pigeon", "chicken" chest) in children is less common than funnel; while 3 out of 4 cases of anomalies occur in boys. With a keeled chest, the ribs join the sternum at a right angle, "pushing" it forward, increasing the anterior-posterior size of the chest and giving it the shape of a keel.
Degrees of keeled chest deformity in children include:
- I - protrusion of the sternum up to 2 cm above the normal surface of the chest;
- II - protrusion of the sternum from 2 to 4 cm;
- III - protrusion of the sternum from 4 to 6 cm.
Acquired deformity of the chest in children is divided into kyphoscoliotic, emphysematous, scaphoid and paralytic.
Symptoms of chest deformities in children
The clinical manifestations of pectus excavatum vary with the age of the child. In infants, the depression of the sternum is usually hardly noticeable, however, there is a "paradox of inspiration" - the sternum and ribs sink down when inhaling, when the child screams and cries. In younger children, the funnel becomes more prominent; there is a tendency to frequent respiratory infections (tracheitis, bronchitis, recurrent pneumonia), fatigue in games with peers.
Funnel chest deformity reaches its greatest severity in children of school age. On examination, a flattened chest with raised edges of the ribs, lowered shoulder girdle, protruding abdomen, thoracic kyphosis, lateral curvature of the spine is determined. The “inspiration paradox” is noticeable when breathing deeply. Children with pectus excavatum have low body weight and pale skin. Characterized by low physical endurance, shortness of breath, sweating, tachycardia, pain in the heart, arterial hypertension. Due to frequent bronchitis, children often develop bronchiectasis.
Keeled deformity of the chest in children is usually not accompanied by serious functional disorders, so the main manifestation of the pathology is a cosmetic defect - protrusion of the sternum forward. The degree of chest deformity in children may progress with age. When the position and shape of the heart changes, complaints of fatigue, palpitations and shortness of breath may occur.
Schoolchildren with chest deformity are aware of their physical handicap, try to hide it, which can lead to secondary mental layers and require help from a child psychologist.
Poland's syndrome or rib-muscular defect includes a complex of defects, including the absence of pectoral muscles, brachydactyly, syndactyly, amastia or atelius, deformity of the ribs, lack of axillary hair growth, and a decrease in the subcutaneous fat layer.
The cleft of the sternum is characterized by its partial (in the area of the handle, body, xiphoid process) or total splitting; at the same time, the pericardium and the skin covering the sternum are intact.
Diagnosis of chest deformities in children
Physical examination of the child by a pediatrician reveals a visible change in the shape, size, symmetry of the chest; detect functional heart murmurs, tachycardia, wheezing in the lungs, etc. Often, when examining children with chest deformity, various dysembryogenetic stigmas are revealed: joint hypermobility, nystagmus, gothic palate, etc. The presence of objective signs of chest deformity requires an in-depth instrumental examination of children under the direction of,
With a funnel chest, conservative measures are indicated only for the I degree of deformation; at II and III degree, surgical treatment is necessary. The optimal period for surgical correction of the funnel chest is considered to be the age of children from 12 to 15 years. In this case, the fixation of the corrected position of the anterior chest can be carried out using external sutures made of metal or synthetic threads; metal clamps; bone auto- or allografts left in the chest cavity, or without their use.
Special thoracoplasty techniques have been proposed for the surgical correction of cleft sternum and costo-muscular defects.
The results of chest reconstruction in children with congenital deformity are good in 80-95% of cases. Relapses are observed with inadequate fixation of the sternum, more often in children with dysplastic syndromes.
Curvature of the chest is a relatively rare defect - it occurs in two children out of a hundred. Most often, the diagnosis is made soon after or during infancy. Particularly pronounced can be suspected even by parents. The danger of a curvature of the chest in a child is a violation of the functions of the respiratory and cardiac systems, as well as psycho-emotional disorders due to a pronounced defect in appearance.
Brief description and classification
This deviation in the structure of the chest can be congenital (diagnosed in 1-2% of babies) or acquired pathology (noted in 14% of adults and adults), characterized by changes in the structure, volume and proportions of the chest. They negatively affect the location, condition and operation of many organs and systems. 
There are three main types of curvature:
- Funnel-shaped. It visually looks like a depressed or sunken chest, which is why it is often called the "shoemaker's chest." The only effective treatment for pectus excavatum in children is surgery, as the disease tends to progress during adolescence.
- Keeled ("chicken breast"). The causes of pathology include some defects,. In 20% of cases, keeled curvature is diagnosed along with scoliosis, with age the defect becomes much more pronounced. You can detect this pathology at an early age - at 3-4 years.
- Flat chest. With this pathology, there is a decrease in the volume of the chest, the child is characterized by an asthenic physique: high growth, low body weight and long limbs. With this defect, the child is more prone to colds.
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In the first type of pathology, there are several degrees of severity:
- mild degree - depression up to 2 cm;
- medium degree - depression from 2 to 4 cm;
- severe degree - depression up to 6 cm.
- Arched chest (Currarino-Silverman syndrome). An extremely rare pathology.
- Poland syndrome.
- Cleft of the sternum.
Why does
There are two main versions of occurrence:
- genetic predisposition. If the disease occurs in distant and close relatives, then with a high probability it will manifest itself in the child.
- Negative impact of external and internal factors on a woman and during the first trimester, when the laying and formation of bone and cartilage tissues of the chest occurs. Among the negative impacts are the use of alcohol, infectious diseases, strong psycho-emotional shocks.
- chronic diseases of the respiratory system;
- rickets;
- kyphosis;
- bones;
- or Turner;
- severe chest injury.
How does it manifest
Most often, parents can suspect the presence of a defect by visual signs: the chest becomes disproportionate, sunken or concave, protruding like the keel of a ship. In this case, the curvature of the spine occurs. Breast curvature is also accompanied by other symptoms:
- paradoxical breathing, in which the ribs sink down at the time of inspiration, which leads to respiratory failure;
- limitation of motor activity;
- developmental delay;
- shortness of breath, vegetative;
- rapid fatigue during physical exertion;
- weakness;
- frequent respiratory illnesses.
Which doctor should be consulted
Breast curvature requires the participation of many specialists who will not only eliminate the pathology, but also, if necessary, normalize the psychological state of the child. If a pathology is detected, the help of such doctors may be required:
- thoracic surgeons, in whose competence are the organs of the chest;
- orthopedists, if the pathology affects the functioning of the limbs and spine;
- traumatologists;
- cardiologists, if the curvature disrupts the work of the heart;
- pulmonologists, if the curvature disrupts the functioning of the respiratory system;
- geneticists;
- child psychologists if the curvature affected the emotional state.
How is the diagnosis
As a rule, the diagnosis of curvature of the chest does not cause difficulties. For diagnosis, physical and functional methods are used, less often instrumental and laboratory studies. Initially, the pediatrician examines the child to identify:
- size, shape of the chest;
- degree of curvature;
- noise and other disorders of the heart;
- respiratory and work disorders.
ECG and spirography are used to establish functional disorders in the work of the heart. Also, these methods are informative for evaluating the effectiveness after treatment. Among the instrumental methods used are:
- The exact shape and degree of curvature can be determined using x-rays. It is done in two projections: front and side.
- CT can detect compression of the lungs, displacement of the heart.
- MRI is rarely done. The study gives an extensive picture of the state of bone and soft tissues.
Fundamentals of effective treatment
If the pathology is congenital, it is an independent diagnosis, however, in the case of acquired curvature, every effort must be made to combat the underlying pathology, which led to breast deformity. Treatment is more successful in children, as their bone and cartilage tissue is more pliable and flexible. Therefore, if the pathology is noticed at the initial stage and is slightly expressed, it makes sense to try to eliminate it by traditional methods.
However, very often adults aged 30-40 turn to doctors, in whom the pathology as a result of prolonged exposure leads to severe disorders of the heart and lungs, to the displacement of organs and the spine. It is extremely important to see a doctor as soon as you suspect any abnormalities in your child.
Important! Parents whose children are diagnosed with this pathology should clearly understand that conservative methods (exercise therapy, massage, corsets, exercises, etc.) are in no way able to eliminate a pronounced pathology. However, they must be performed for the normal functioning of the respiratory and cardiac systems. A curvature that disrupts the functioning of the lungs and heart is treated only surgically!
conservative methods
Conservative methods of treatment are used in the following cases:
- If the deformation delivers only (!) aesthetic discomfort and does not affect the operation and location of the internal organs.
- After the operation to eliminate the residual effects of deformation.
- To normalize and maintain the functioning of the lungs, heart, musculoskeletal system.
Important! When performing breathing exercises, it is extremely important to monitor inhalation and exhalation: inhalation occurs through the nose, exhalation through the mouth. Also, breathing is important during physical activity - at the moment of effort, you should always exhale.
However, most often, children and adults with a diagnosis of chest deformity are shown surgical treatment. Surgical correction
The following criteria are considered indications for surgical correction:
- The curvature negatively affects the functioning of the internal organs, leads to their displacement, and is the cause of labored breathing and heartbeat.
- The curvature gives a person such a strong psychological discomfort that it interferes with normal interaction in society.
- The curvature significantly affects the spine and. This is dangerous due to the formation, pinching and inflammation of the nerves, severe pain syndrome, protrusion.
- With the use of implants.
- With the use of internal / external fixators.
- Flip of the sternum by 180°.
- Operations without the use of clamps.
After some types of operations (sternochondroplasty), patients need to observe strict bed rest for about a month, in other cases, a massage can be started in a week to speed up rehabilitation. Regarding the best age for intervention, opinions differ - some experts believe that intervention is most effective at the age of 3-5 years, while others recommend performing the operation at 12-16 years. Therefore, to exclude doubt, it is necessary to consult with a qualified specialist, and preferably several. Did you know? Since ancient times, doctors have used dangerous and harmful substances as anesthesia: opiates, marijuana, cocaine, alcohol, and even strong blows to the head in order to stun a person. In the 19th century, there were attempts to use nitrous oxide - the substance caused inadequate fits of laughter, and at the same time was an anesthetic. And only a little later they began to use medical ether.
Possible Complications
The development of complications and recurrences after surgical correction depends on many factors - the age of the patient, the type of operation, the severity of the deformity, the presence of an initial or concomitant. Most often, a relapse occurs - the re-formation of a defect, and the more complex the initial pathology, the higher the chances of a relapse after surgery. 
In the first hours after the operation, the body of the operated patient adapts to new conditions. At this time, respiratory failure is possible. Its causes are fluid and air in the pleural cavity, and sputum in the respiratory tract, retraction of the tongue. To alleviate the condition and eliminate the lack of air, the patient is shown oxygen and mixtures after the operation. Among other complications, in addition to relapse, the following are possible:
- allergic reaction to implants, retainers and metal plates;
- twisting of the plate, if the operation was performed without clamps;
- inflammation of the pericardium;
- the occurrence of a keeled curvature.
Preventive measures
Since the exact causes of chest deformity have not been established, the methods of prevention to avoid treatment are rather subjective. 
Most experts give the following recommendations:
- In the period, especially in the early stages, exclude the intake of alcohol and any drugs, minimize stressful situations, avoid taking it if possible. During the height of epidemics, expectant mothers should not visit crowded unventilated places so as not to catch the infection.
- Also, during the gestation period, it should be correctly drawn up. The same applies to the baby when he stops eating mother's milk.
- At an early age, the child should be systematically examined for the purpose of prevention and early detection of the defect.
- From an early age, the baby needs to instill a love for sports and exercise, to encourage an active lifestyle. This will have a positive effect on posture and the entire musculoskeletal system.
- It is necessary to treat all acute and chronic diseases, especially those affecting the respiratory tract, in time.
- Avoid injury, burns.
Chest deformity - acquired or congenital change in the shape of the chest (musculoskeletal frame of the upper body, protecting the internal organs). Pathology has a progressive course.
Causes
The main causes of breast curvature are genetic anomalies (Marfan's syndrome, osteogenesis anomalies, Turner's syndrome, Down's syndrome, achondroplasia, etc.). Genetic defects determine the disproportionate development of bone and cartilage tissue. This leads to asymmetry of the ribs and sternum, concavity and convexity.
Chest deformity is acquired and can develop as a result of diseases such as scoliosis, rickets, tuberculosis and syphilis of the bones. The cause of deformation can be mechanical trauma.
Symptoms of chest deformity
The main symptoms of the disease:
- Visible deformity of the chest
- Cardiovascular disorders
- Respiratory dysfunction
Clinical manifestations of chest deformity depend on the type and degree of pathology.
With a funnel-shaped deformity, the sternum bone is pressed inward, towards the spine. The deepening of the lower part of the chest and the upper part of the abdominal wall looks like a funnel. The chest appears to be enlarged.
For keeled deformity of the chest, the protrusion of the sternum forward in the form of a keel is characteristic. The size of the chest is increased. The front of the diaphragm is missing. With age, the volume of the chest decreases.
With a flat chest, the dorsal and pectoral muscles are weak, the chest is elongated and flattened, the shoulder blades are raised, and the shoulders protrude forward.
Poland's syndrome (costo-muscular defect) externally manifests itself in the form of a partial or complete absence of the pectoral muscles. It may be accompanied by the absence or deformation of the ribs, a decrease in the layer of subcutaneous fat, underdevelopment of the upper limbs, fusion or shortening of the fingers, the absence of mammary glands or nipples.
Congenital cleft sternum is manifested by complete or partial splitting of the middle part of the chest. In this case, the heart and main vessels are not protected by the chest.
The bifurcation or absence of the xiphoid process is an anomaly of the lower part of the sternum.
Pathology may be accompanied by a feeling of discomfort, vegetative-dystonic disorders, cardiopulmonary insufficiency, anemia.
Diagnostics
Diagnosis of pathology is based on the results of an examination of the patient by an orthopedic surgeon and instrumental studies:
- X-ray of the chest in two standard projections
- Ultrasound by polyposis scanning
- ECG and echocardiography to assess the state of the heart
- Examination of the function of external respiration
Classification
The main types of chest deformity:
- funnel-shaped
- Keeled
- flat
The following types of deformations are extremely rare:
- Congenital cleft sternum
- Rib-muscular defect (Poland syndrome)
- Arched chest (Currarino-Silverman syndrome)
There are the following types of acquired deformity:
- emphysematous
- Paralytic
- Scaphoid
- Kyphoscoliotic
Patient's actions
If a chest deformity is detected, the patient should start treating the pathology as soon as possible using the methods recommended by the orthopedic surgeon.
Treatment of chest deformity
Treatment is carried out with the help of physical exercises, therapeutic massage, as well as conservative and surgical methods. The choice of treatment method depends on the type and degree of deformity, the age and condition of the patient.
At the initial stages of the pathology, exercises are prescribed to strengthen the muscular corset of the upper body. A set of exercises is selected individually. Conservative treatment involves taking drugs to eliminate symptoms and disorders of the internal organs that have arisen as a result of pathology.
Correction of curvature in newborns is possible with the help of special medical techniques. One of them is the traction of the chest wall under the influence of vacuum.
Surgical treatment is aimed at restoring the anatomical position of the chest structures. This type of treatment includes the procedure of stendrochondroplasty, the operation according to the Nass method.
Complications
Pathology can disrupt the mechanics of breathing, reduce the volume of pleural cavities, contribute to the development of diseases of the bronchopulmonary system and respiratory failure. In adult patients, chest deformity provokes the appearance of arrhythmias, angina pectoris, and hypertension.
Pathology is often the cause of psychological problems, especially in adolescents.
Prevention of chest deformity
Prevention of chest deformity includes:
- Mandatory medical supervision of pregnancy
- Prevention and timely treatment of rickets
- Timely treatment of COPD
- Treatment of degenerative diseases of the spine
Chest deformity in children is a pathological condition with a change in the shape of bone and cartilage structures. This type of pathology occurs in 2% of newborns. In infants, it is hardly noticeable, but by the age of three, the developmental anomaly becomes pronounced.
The chest is a musculoskeletal frame located in the upper half of the body. It serves as protection for the heart, lungs, blood vessels. With an anomaly, the cartilages of the costal arches with the sternum are deformed.
With congenital pathology, the defect develops even at the embryonic level: the right and left rudimentary cartilages of the sternum are incorrectly connected or there is a defect in the form of a cleft between their upper and lower sections. The cleft can be so large that there is a risk of pericardial protrusion with congenital heart defects.
About 4% of newborns are born with congenital malformations in the thoracic bone structures. Bone and cartilage defects reduce the protective and frame function, a pronounced cosmetic defect causes psychological disorders in babies. Deformation of the chest in children is accompanied by a disorder of the circulatory system, and children with such a pathology are excessively asthenic, physically lagging far behind healthy peers.
According to the degree of structural changes, the child's condition is assessed as:
- compensated;
- subcompensated;
- decompensated.
The degree of compensation depends on the characteristics of the body, the growth rate of bone structures, the degree of stress, and other existing diseases.
Localization of changes in bone structures is:
- along the front surface;
- on the back surface;
- along the side surface.
If a child is born with dysplastic (congenital) anomalies, then the acquired causes of pathology with deformation can develop against the background of chronic pulmonary diseases, tuberculosis, rickets, scoliosis, injuries, burns.
A congenital anomaly of development is associated with the underdevelopment of a whole complex of structures: the spine, ribs, sternum, shoulder blades, muscles in the chest. The most severe anomalies of the bone structures are manifested along the anterior surface of the chest - this is a funnel-shaped, flat, keeled deformity of the chest in children.
Congenital pectus excavatum (CPHD) is also called "cobbler's chest". With this congenital pathology, the costal cartilages are so defective that they give a recess along the middle and lower third of the chest. This congenital anomaly ranks first in number - about 90% of cases.
External signs by which a funnel-shaped deforming pathology is determined:
- the chest has a shape with expansion in the transverse direction;
- signs of kyphosis with lateral curvature.
As the child grows older, this type of deformation manifests itself more and more.
The costal bones grow and push the sternum inward. The sternum becomes concave, shifts to the left side and unfolds the heart along with large vessels.
This type of defect gives a decrease in the volume of the chest cavity.
A curved spine and an irregular, sunken shape of the chest displace the heart and lungs.
Arterial and venous pressure changes. Children with pectus excavatum suffer from multiple malformations, often due to a positive family history.
Symptoms that develop against the background of this type of deformation:
- lag in physical development;
- vegetative disorders;
- chronic colds.
Usually, by the age of three, the degree of deformation reaches its peak and then becomes fixed.
There are 3 degrees of severity by displacement:
- at the first displacement depth of about 2 cm;
- on the second - about 4 cm;
- on the third - more than 4 cm.
The keeled anomaly is called "chicken breast". This is such a deformation when the sternum is convex, protrudes forward. The anteroposterior dimensions are enlarged.
The keeled anomaly occurs due to overgrown costal cartilages of the fifth-seventh rib. The sternum protrudes forward, the angles of the costal arches are in relation to it at an acute angle (keeled shape). Most often, this form of anomaly is congenital, but there are cases of complicated forms of rickets, bone tuberculosis.
Keeled growth is observed in children from 3 to 5 years. With growth, the deformation becomes more noticeable. The heart changes. This is the so-called hanging heart syndrome. In rare cases, the keeled anomaly is accompanied by pathology of the pulmonary and cardiac structures. In children, this is most often a cosmetic defect, and doctors do not observe any abnormalities. By adolescence and older, a keeled anomaly of the chest can provoke functional disorders associated with a significant decrease in lung volume. The oxygen consumption coefficient is significantly reduced. Patients with keeled chest deformity are concerned about shortness of breath. They complain of fatigue, palpitations after minor physical exertion.
Surgical correction is prescribed only when the doctor objectively determines that there are abnormalities in the functioning of the internal organs.
A flat chest is considered a feature of the physique. In this case, the anteroposterior dimensions of the chest are reduced, but there are no disturbances in the functioning of the internal organs. This variant is not considered a pathological condition and therapy is not indicated here.
Congenital deformities also include convex sternum, congenital cleft sternum, Poland's syndrome.
Curved sternum (Currarino-Silverman syndrome) is the most rare type of deformation of the chest bone structures. It is a protruding groove along the upper third of the chest: the ossified sternum with overgrown cartilage of the right and left costal arches form a groove. With this type of deformity, the rest of the chest bone structures look normal.
This deformation does not pose a threat to the health of the patient and is only a cosmetic defect.
A congenital cleft in the sternum is an anomaly in which the sternum is completely or partially split. It is considered a serious and dangerous malformation. In addition to a cosmetic defect, the depression along the anterior surface of the chest does not protect the heart with the main vessels. Respiratory excursion of the chest with such a congenital defect lags behind the age norm by 4 times. Decompensation from the cardiovascular and respiratory systems increases over a short period of time.
An operation is indicated to correct a congenital cleft breast.
The specialist determines the diagnostic picture of the development of deformation by external signs. X-ray and MRI are used as instrumental diagnostic methods.
With the help of MRI, bone defects, the degree of lung compression and mediastinal displacement are detected. The study also makes it possible to identify the pathology of soft tissues and bone structures.
If the doctor suspects that the work of the cardiovascular and pulmonary systems is impaired, he prescribes echocardiography, monitoring of the heart rate according to the Holter method, and an x-ray of the lungs.
Chest deformity in children is not treated with conservative methods of therapy (drugs, massage, physiotherapy exercises).
If the defect is minor, and there are no significant cardiorespiratory dysfunctions, the child is observed at home.
If there is a second or third degree of displacement, surgical reconstruction is indicated. Usually small patients are operated on at the age of 6-7 years. There are many methods of correction with the help of surgical intervention, but the positive effect of surgical correction is achieved only in half of the children.
Each operation is performed in order to increase the volume of the chest and straighten the curved spinal column. After that, supportive treatment is prescribed: massage courses, corrective exercises, wearing orthopedic corsets.
Additional sources:
1. Kosinskaya N.S. Violations of the development of the osteoarticular apparatus. Section: Orthopedics and traumatology www.MEDLITER.ru electronic medical books
2. Bukup K. Clinical study of bones, joints and muscles. Section: Orthopedics and traumatology www.MEDLITER.ru electronic medical books
Curvature of the ribs leads to. The condition is dangerous to human health. Reducing the size of the chest cavity is accompanied by compression of the heart and lungs. Against this background, congestive changes in the pulmonary vessels occur, which can provoke the accumulation of infiltrate in the pleural cavity (exudative pleurisy), in the pericardial region (pericarditis) and other serious complications.
The most common causes of curvature of the chest are birth defects. Funnel-shaped or leads to curvature of the ribs. If the pathology is not treated, it will progress throughout life. With early therapy, negative consequences can be avoided.
The causes of such conditions are 2 factors:
- congenital deviation of the sternum;
- proliferation of costal cartilage.
In the presence of additional cartilaginous asymmetries, the child first has a crooked chest on one side. If the defect is not corrected in a timely manner, a complex deformation occurs with curvature of the ribs, which can only be eliminated in an operative way. Let's consider the above facts in more detail.
Congenital pathologies
The curvature of the ribs in a child is provoked by congenital and acquired factors. Congenital anomalies leading to chest asymmetry in a child:
- violation of the formation of bone and cartilage tissue;
- neurological diseases with a block of muscle innervation;
- anomaly of the sternum (cleft, doubling).
In rare cases, a child may have a combined pathology. For example, a sunken (funnel-shaped) chest can be combined with a convex (keeled) chest. Pathology is complicated against the background of damage to the diaphragm. In such a situation, in children, the displacement of the ribs is observed simultaneously with hernias of the esophageal opening of the diaphragm.
Scientists are actively studying the causes of funnel-shaped and keeled deformation. It was found that pathology is more often observed in girls (4 times more often). Clinical experiments have established that most patients with this disease also have changes in the costochondral cartilage. They can be one-sided and two-sided. 
Sternal defects
Defects of the sternum are divided into 3 types:
- cervical and thoracic ectopia;
- splitting of the sternum;
- displacement of the heart.
The heart is not protected by dense tissues, so its expansion and displacement leads to a curvature of the chest. When the heart is displaced, it is very difficult to effectively treat the pathology. Literary sources say that after surgery, only 3 out of 30 children experienced relief.
With cervical ectopia of the heart, the organ is displaced upward. In such a situation, the prognosis is extremely unfavorable (up to lethal). In children with abdominal localization of the organ, the chances of survival are higher. Defects in the abdominal wall are sutured surgically, and curvature of the ribs is corrected with plastic surgery.
Polland and Wife Syndromes
Syndromes of rare congenital anomalies of the chest include:
- Poland;
- Wife.
Poland's syndrome refers to diseases that develop as a result of anomalies of the following muscle groups:
- small and large chest;
- anterior dentate;
- intercostal.
The disease develops rarely with a frequency of 1 case per 30,000 children. Pathology occurs in boys 3 times more often than in girls. In 75% of cases, the right side is affected. Against the background of pathology, scientists often reveal underdevelopment of the subclavian artery and some internal organs.
Often, Poland's syndrome is combined with a congenital Mobius anomaly. With it, cosmetic defects, swelling of the lung are observed. In some patients, against the background of pathology, functional respiratory disorders occur. Nevertheless, the lungs themselves do not change with pathology.
Wife's syndrome is a breast dystrophy resulting from lung hypoplasia and bone dysplasia. The pathology was first described in 1954. In most cases, Wife's syndrome is hereditary. It is passed down from generation to generation in an autosomal recessive manner.
Is it possible to fix the problem
The crooked chest in a child due to multiple complications and the presence of pathological displacements of the internal organs requires careful selection of treatment tactics. Conservative and surgical methods are used to correct the curvature of the ribs.
Principles of conservative treatment:
- wearing orthopedic orthoses;
- anti-inflammatory and analgesic drugs;
- symptomatic treatment;
- correction of metabolic disorders;
- physiotherapy.
The above procedures are rarely effective. They only help prevent the progression of the disease. Applied conservative treatment and before surgery.
Surgery
Surgical treatment of rib displacement is based on the use of the following methods:
- thoracoplasty according to Kondrashin, Urmonas and Ravich - involves the restoration of the rib-sternal complex without artificial fixators;
- thoracoplasty according to Marshev, Plakseichuk, Gross, Gafarov and Isakov - involves the use of external fixators;
- methods of turning the sternum at an angle of 180 degrees and excluding the pathology of the muscular system;
- the use of artificial implants to eliminate small deformities of the 1st-2nd degree;
- thoracoplasty according to Timoshchenko, Reichben and Nass - involves the installation of internal fixators.
The crooked chest in a child is most effectively eliminated with the help of surgery. Implantation of special plates helps to prevent curvature of the chest and correct the restoration of the ribs. Internal implants help shorten the rehabilitation period. The device does not interfere with the usual way of life and does not cause discomfort in the child.
