'World's Smallest Girl' Beats the Odds

Dr. Soni said Jyoti's fractures had gone into pseudoarthrosis, a condition in which a false joint forms at the point of fracture. It mitigates the pain but basically creates another point at which the leg bends.

In the long-term, he said not only will she be unable to walk independently, her nerves and blood vessels also might suffer as a result.

But Dr. Soni thought an operation to remove the false joints, realign the bones and then insert custom-made metal alloy rods to keep the bones straight could fix her legs.

"I thought it could help her in many ways," he told ABCNews.com in a phone interview.

But before the operation, he wanted to run a battery of tests to better understand Jyoti's condition.

"We would like to know the underlying pathology. Why she has not developed," he said, explaining that blood tests would reveal hormone deficiencies and give insight into Jyoti's small size. "That would influence my treatment."

Jyoti's Parents Want Guarantee That Surgery Will Be Successful

Jyoti's parents were anxious about the surgery from the start, Dr. Soni said, wanting an impossible "guarantee" from him that the surgery would help her legs and not harm her life.

But "it's not free of risk and I [couldn't] guarantee the parents," he said.

Although they agreed to the blood tests, when a first attempt to draw blood proved unsuccessful and led Jyoti to tears (finding the vein on a small child can be difficult), Jyoti's parents decided against the surgery.

Dr. Soni said it was frustrating but "because she's so tiny, the parents could not see their child screaming. ... They decided to get treatment from the local indigenous doctor.

"It would have made me extremely happy if she hadn't refused [surgery]," he said. "But that's life."

Although the local doctor guaranteed the family that a paste applied to the leg would heal the fracture, Dr. Soni said nothing aside from surgery will heal her.

Blood Tests Would Explain Jyoti's Small Stature

He said he wishes Jyoti the best, but given what he does know about her condition, he said, "In a normal person, if you break a bone, if you hold it still long enough it will heal. In Jyoti's case it will never heal."

Estimating that she would live to be about 35 to 40 years of age (although acknowledging that there was much he was not able to find out about Jyoti's condition), Dr. Soni is concerned that her untreated injuries will hinder the pursuit of her dreams.

Dr. Paul Desrosiers, director of pediatric endocrinology at the Arnold Palmer Hospital for Children in Orlando, Fla., said blood tests could uncover the reason for Jyoti's short stature.

Based on what he knows of Jyoti's condition (although he has never examined her), he said it is possible that she has panhypopituitarism, a very rare deficiency involving all of the functions of the pituitary gland. He thinks she might not have a pituitary gland at all or at least does not have any of the hormones for which it is responsible.

According to the nonprofit MAGIC (Major Aspects of Growth in Children) Foundation that supports parents of children with growth disorders, hypopituitarism occurs in 1-1.5 per 100,000 individuals. Dr. Desrosiers estimated that panhypopituitarism is even rarer.

Had Jyoti's condition been diagnosed at birth by geneticists and endocrinologists, it's probable that hormone injections would have helped her reach normal height and development, he said.

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