The one of the most frequent questions that is asked to the orthopedist is whether the growth of the child is at normal range and how long the child will be at maturity. In order to give an answer to these questions, it is necessary to watch he growth for a time and use certain formulas. With the help of these formulas, rate of growth and height at maturity can be estimated.
Shortness is a relative term that can change due to gender, society, and person. 170cm can be considered tall for women but short for men; short in Scandinavia but all in China. Two people at the same height can have different views about their height..
So, how do we describe shortness? People who are below the average height level of the society and who consider themselves as short are short. According to Turkey’s averages, below 150cm in women and below 170 in men are considered short.
Dwarfism is a genital condition that can be caused by more than 200 reasons. Even though the parents usually have normal height, genetic defect can first be seen at child. Height varies between 100-140cm and various problems such as spine curvatures, curvatures at legs and arms, motion limitations at joints, and problems that occur at internal organs accompany the shortness. When planning the treatment, these conditions must also be kept in mind.
It will be right to observe the treatment in two groups: treatment that allows the patient to continue his normal life and cosmetic surgeries. First group especially consists of nerve compression, problems due to loss of stability of neck bones, and difficulty in walking due to joint problems.
Cosmetic treatment in shortness is lengthening and aligning the bones. The child should decide this treatment with the family because the treatment will continue until he child matures and can have problems herewith. As pediatric orthopedic surgeons, we openly explain all the surgeries and indications that can arise to the family. The decision here is to choose the best for the child, not to address the family’s expectations.
Our goal as surgeons for the child is to reach 150 cm at maturation. To reach this goal, the treatment starts at pre-school period (6 year old). With the use of computer animations, the body shape after the lengthening can be presented to the family. The treatment varies from surgeon to surgeon but usually a 10 cm lengthening is made at the femur with apparatus so the child starts school at normal height. After two years, another 10 cm lengthening is made at the tibia with similar apparatus. If the lengthening procedure is to be continued, lengthening at the femur and tibia is made after 2 years. After these treatments, arms are visually short so after this period or after the first lengthening period, we can also lengthen the arms.
The problems that await the family during this period are pain and motion limitations. Good rehabilitation is necessary and the most important element that affects the treatment. Knee and ankles should be protected and the child should be encouraged to move. Total treatment time is 1 cm per month; therefore, 10 months is needed for a 10 cm lengthening. To shorten this time, we can apply nails that can lengthen from within the bone.
Because there is not enough urbanization in our country, it is hard for short people to continue their daily lives. High sidewalks, telephone boxes, use of buses, high bus seats, high toilet seats, and reaching the doorknobs are some of those difficulties.
The happiness of an elementary student, who is a patient of mine, after being able to open the door by herself was worth seeing and things we do not see as important can be a very big difference for these people.
Not depending on good or bad outcomes, we should do the lengthening procedure on chosen suitable patients and we should try to make the surrounding factors suitable for them.
In children with shortness;
- We should treat them according to their age, not height
- Put effort for your child to get used to conditions
- Put your child’s expectation is front, not yours
- Encourage them to go to normal schools and talk to the teacher
- Encourage them to do sports
- Fix them up with social organizations
- And never forget, small people live big