Short stature: Treatment options

Dwarfism refers to a state when a person is short in stature either because of their genes or medical reasons. As per the Little People of the World Organization (LPOTW) any adult under the height of 4 feet 10 inches can be considered a dwarf. Other groups extend the criteria for certain forms of dwarfism to 5 feet, but the average height of an adult with dwarfism is 4 feet. Some people use the term ‘short people’ or ‘short stature’ over dwarf which is why it is important for us to be sensitive about the words we use so to make the other person feel welcomed and cared for.

Dwarfism Correction:

It is pertinent to note that not every person with dwarfism needs any form of correction. A lot of people often tend to use extrinsic things like chairs, shoes, etc. that help them with their daily work and activities. Treatment is a personal choice and should be made only after weighing all the pros and cons along with the chances of any possible risk.

What are the goals of this process?

•   To obtain a functional height, normally between 4 feet and 10- 5 feet and 2 inches;
•   To correct deformities like bowlegs to improve walking;
•   To lengthen the arms to a functional length for self-care and driving; and
•   To gain secondary psychological benefits from a more positive body image and body function.

Hormone Therapy:

For people with growth hormone deficiency, injections of synthetic human growth hormone may be helpful. Children receiving this treatment don’t always reach an average height, but they can get close. Girls with Turner’s syndrome may need oestrogen therapy to trigger the growth of female hormones and functioning. These might be needed till the time a woman hits menopause. 

Limb Lengthening:

Limb lengthening is a procedure to lengthen the bones in the arms or legs. This is done as a gradual process, so that the bones and soft tissues (skin, muscles, nerves, etc.) slowly increase in length. Usually this process takes a long time and is often done with some sort of gradual or acute deformity correction. During the surgery two separate bone segments are created by dividing the bone into two parts and then the lengthening device is inserted within. Orthopaedic devices that are inserted within the bone are known as ‘internal devices’ whereas, devices that remain outside the body are called external fixators.  The first surgery should usually take place between the ages of 8-10 as it is considered to be the ideal age since starting the surgery before this age can lead to inhibition.

After surgery, a resting period is followed by for a period of five to eight days so that the healing process can be started. This period of time is called the latency period. After the latency period, the patient will adjust the orthopaedic device so that it slowly pulls apart the two bone segments. This gradual process of slowly separating the two bone segments is called distraction, which means “pulling apart.” As the two bone segments are slowly pulled apart, new bone forms in the space between them. This new bone increases the overall length of the bone. The new bone is called regenerate bone

Spinal Decompression:

Spinal decompression works through lightly stretching the spine. That changes the force and position of the spine. This removes stress off the spinal disks that are gel-like cushions among the bones for your spine. As a result, bulging or herniated disks might also additionally retract, taking stress off nerves and different systems for your spine. This in turn, allows the motion of water, oxygen, and nutrient-wealthy fluids into the disks on the way to heal.

Benefits of lengthening: 

Everyday items in our society are designed to be at least 152 cm (5 ft) tall. Door knobs, light switches, and car gas and brake pedals are out of reach of most people with dwarfism. Short arms can make personal hygiene difficult, and movement in the lower back and spine can decrease, especially as you age. People with dwarfism who drive are at risk of injury due to the short distance between the steering wheel and the airbag. However, disabling the airbag increases the risk of serious injury if the driver hits the steering column with the chest.  People who are below 5 feet eventually realize how society was built on a one track mind and not a lot of things are easy for them. This is why the main underlying benefit of lengthening is psychological. A lot of people who want to live a normal life without compromising on their lifestyle choose to undergo through the surgical process.

Complications related to surgery:

While limb lengthening might feel like the ideal option, it is important for you to understand the complications that are attached to it. Most of the complications include:

Infections–

infections can occur either at the pins and wire side or at the incision side. While the former are common and less serious, the latter are a little more complicated. Most of the infections can be cured with a regular course of anti-biotic and careful cleaning of the sites infected. Signs of infection include:

• pain around the pin, wire or incision site
• warmth around the site
• redness around the site
• swelling around the site
• pus, yellow or green drainage from the site

Issues related to healing–

rapid healing or too slow healing are another problem one should keep in mind. Rapid healing is a problem because it can lead to the bone getting struck (where it cannot grow anymore). In such cases the bone speed must be increased to keep up with the healing speed which is why it is important to keep a check.  If a bone is healing way too slowly then the process must be slowed down further to keep in pace with the bone healing.

Bent or Broken bones–

newly fixed bones are very likely to bend or break especially with the fixators on. Most of the times it can be fixed by your doctor. It is very rare that a bone will break or bend once the fixator has been removed.

Muscle stiffness-

when the limb is being expanded, the muscle and the joints around it are also expanding which can lead to stiff and sore muscles. If the muscles and joints get too stiff where it is very difficult to even move them then the doctor will slow down your limb expansion process and give your body time to heal.

Limb treatments are a complex process which is why choosing a clinic that puts your needs first is of utmost importance. Not only you need professionals who understand the need of the hour but also understand what the patients want. At Young Bones Clinic we put the needs of our patients before anything else which is why we are the perfect choice for your treatment.

Coping and Support Mechanisms:

Modify your home-

making some changes to make your child’s life easier is always encouraged. Putting extensions on switches, using lower handrails on stairs, switching to size appropriate furniture and daily use tools for your kids can inculcate a sense of normalcy.

Seek help–

it is equally important for the parents to be mentally prepared and not get frustrated or disheartened at their child’s condition since it can make them feel vulnerable. It is advised that parents should undergo therapy and talk to educators to understand the changes that are happening with their kids.

Talk about bullying-

more often than not kids who are a little different are subjected to bullying by their peers who don’t understand their condition. It is important to build a dialogue between the school counsellor and your child to ensure that they are not being subjected to any form of harassment by the peers or the teachers that can possibly mentally scar the child.