MEASUREMENTS, CASTING & RECTIFICATION FOR TRANS-FEMORAL (TF) QUADRILATERAL SOCKET

1. MEASUREMENTS, CASTING & RECTIFICATION FOR TRANS-FEMORAL (TF) QUADRILATERAL SOCKET

2. DISTRIBUTION AND FUNCTION OF MUSCULE GROUPS FLEXION OF THE HIP ADDUCTION OF THE HIP RECTUS FEMORIS ABDUCTION OF THE HIP ADDUCTORS ABDUCTORS FEMUR HAMSTRINGS GLUTEUS MAX EXTENSION AND INTERNAL ROTATION OF THE HIP EXTENSION OF THE HIP ISCHIUM

3. ML FINAL LOOSE TIGHT A - P ISCHIAL HEIGHT KNEE HEIGHT HEEL HEIGHT FLEXION ABDUCTION CIRCUMFERENCE CALF CIRCUMFERENCE ANKLE L R SIDE FOOT SIZE TRANS-FEMORAL MEASUREMENTS MEASURES

4. TECHNICIAN CONTERFORCES TO ADDUCTION PATIENT FORCES TO ADDUCTION CLEAR APPEARANCE OF ADDUCTOR LONGUS TENDON AP MEASURE : DISTANCE BETWEEN ISCHIUM AND ADDUCTOR LONGUS TENDON TRANS-FEMORAL MEASUREMENTS

5. LENGTH OF FEMUR LENGTH OF STUMP TRANS-FEMORAL MEASUREMENTS STUMP MEASUREMENTS NB: THESE MEASUREMENTS HAVE FROM RAMUS AND/OR ISCHIAL TUBEROSITY

6. SHORT STUMP ABDUCTION/ADDUCTION = 0° TF STUMP ABDUCTION-ADDUCTION MEDIUM AND LONG STUMPS ADDUCTION = 5 - 7° WARNING: FIGURES ARE GIVEN AS GENERAL GUIDENCE WHILE EACH PATIENT IS UNIQUE !

7. LONG STUMP SHORT STUMP FLEXION = 0- 3° FLEXION = 7-10° TF STUMP FLEXION MEDIUM STUMP WARNING: FIGURES ARE GIVEN AS GENERAL GUIDENCE WHILE EACH PATIENT IS UNIQUE ! FLEXION = 3- 5°

8. POSTERIOR GLUTEUS MAX ISCHIUM HAMSTRING TENDON LATERAL MEDIAL TROCHANTER RECTUS FEMORIS PROMINENCE OF SCARPA'S TRIANGLE ADDUCTOR LONGUS ANTERIOR CASTING TF QUADRILATERAL 105° POSITION OF THE HANDS

9. HORIZONTAL PLACE FOREFINGER HORIZONTALLY TO MARK THE ISCHIAL SEAT AND POSTERIOR SHELF THUMB PRESSES BEHIND AND SLIGHTLY HIGHER THAN THE TROCHANTER CASTING TF QUADRILATERAL POSITION OF THE HANDS FRONT VIEW

10. HORIZONTAL PLACE FOREFINGER HORIZONTALLY TO MARK LEVEL OF MEDIAL SHELF (To be reshaped on the mould; see TF rectification medial view) THUMB PRESSES AT DEEPEST AREA OF SCARPA'S TRIANGLE CASTING TF QUADRILATERAL POSITION OF THE HANDS LATERAL VIEW

11. Wall M - wall A angle = ~105° ~15° 1/2 ML 1/2 ML AP = 1/2 ML ~15° Wall M - wall P angle = ~105° TOP VIEW OF NEGATIVE CAST ML distance = Divide the stump circumference of "0" level by 3.14 . AP distance= Divide ML by 2 ( AP distance to be measured from ischial seat to adductor longus canal

12. TOP VIEW OF NEGATIVE CAST EXAMPLE !!! ~15° ML=172mm AP = 86mm ~15° CIRCUMFERENCE=540mm CIRCUMFERENCE OF "0" LEVEL: 540mm ML DISTANCE: 540 / 3.14 = 172mm AP DISTANCE: 172 / 2 = 86mm

13. PROMINENCE OF SCARPA'S TRIANGLE OPPOSITE ISCHIAL SEAT = 1/3 ML CANAL FOR ADDUCTOR LONGUS ~25mm 1/3 1/3 1/3 1/6 1/6 ISCHIAL SEAT = 1/6 ML SUPERIOR VIEW OF NEGATIVE CAST

14. TRANS-FEMORAL (TF) RECTIFICATION WARNING!!! THE STUMP OF EACH PATIENT IS UNIQUE. THEREFORE ALL MEASURES, FIGURES, COMMENTS ETC IN THIS CHAPTER ARE GIVEN AS GENERAL GUIDENCE AND HAVE TO BE ADJUSTED TO EACH PARTICULAR CASE. ALWAYS CONTROL MEASURES BEFORE AND AFTER RECTIFICATION!

15. 1 - WIDTH OF MEDIAL SHELF = ~15 - 18 mm 2 - MEDIAL SHELF IS INCLINED 10-15° AND HAS RELIEF FOR ADDUCTORS = ~10-15mm 3 - WALL IS FLAT AND VERTICAL ~100mm 4 - SHELF AND WALL REMAIN PARALLEL IN TRANSVERSAL PLANE HORIZONTAL (3) 5 - SHELF AND WALL ARE PARALLEL TO THE LINE OF PROGRESSION (6) ~100 mm ~10-15 mm 6 - POSTERIOR WALL HAS A "POCKET" FOR EXTENSORS ~100mm (shown also on posterior view) VERTICAL 15-18 mm SAGITAL PLANE IS PARALLEL TO THE LINE OF PROGRESSION TF RECTIFICATION: MEDIAL VIEW INITIAL FLEXION = 5° (MEDIUM STUMP)

16. 1 - POSTERIOR SHELF IS HORIZONTAL IN 2 PLANES 2 - BORDER OF POSTERIOR SHELF IS IN 90° WITH BORDER OF MEDIAL SHELF HORIZONTAL 3 - POSTERIOR WALL "POCKET" FOR EXTENSOR = ~100mm ~100 mm 4 - POSTERIOR WALL IS IN 105° WITH MEDIAL WALL VERTICAL 105 ° 90 ° INITIAL ADDUCTION = 5-7° (MEDIUM STUMP) TF RECTIFICATION: POSTERIOR VIEW

17. 1 - HEIGHT OF SUPERIOR MEDIAL EDGE IS = ~ 30 mm ABOVE MEDIAL WALL 2 - ANTERIOR WALL IS IN 105° WITH MEDIAL WALL 3 - HEIGHT OF SCARPA'S TRIANGLE = ~ 100 mm ~15-20 mm 4 – MAX DEPTH OF SCARPA IS ABOUT 15-20 mm FROM ANTERIOR EDGE ~30 mm ~25 mm 5 - DEPTH OF SCARPA'S TRIANGLE = ~ 6-10 mm ~100 mm 6 – MEDIAL EDGE OF SCARPA's IS = ~ 25 mm FROM MEDIAL WALL VERTICAL ~ 6-10 mm 105° ~ 25- 30mm INITIAL ADDUCTION = 5-7° (MEDIUM STUMP) TF RECTIFICATION: ANTERIOR VIEW

18. TF RECTIFICATION: ANTERIOR VIEW Determination of Scarpa's triangle - Take the medial lateral distance and divided by 3 - Mark the of lateral third "a" . (1 - 2 - 3) ~10-15 mm a - Mark the point at 25 m from medial corner "c" ~30 mm c • From point "c" draw a vertical line 100 mm to distal end • = point b ~25 mm - Joint point a,b,c = Scarpa triangle ~100 mm Make your choice according to the size and stump condition b VERTICAL 1 - HEIGTH OF SUPERIOR MEDIAL EDGE = ~ 30 mm 2 - ANTERIOR WALL IS IN 105° WITH MEDIAL WALL 3 - HEIGTH OF SCARPA'S TRIANGLE = ~ 100 mm INITIAL ADDUCTION = 5-7° (MEDIUM STUMP) 4 - DEPTH OF SCARPA'S TRIANGLE = ~ 6-10 mm

19. 60-80 mm VERTICAL TF RECTIFICATION: LATERAL VIEW 1 - HEIGTH OF SUPERIOR EDGE = 60-80 mm 3 2 - INITIAL FLEXION : 5° ( MEDIUM STUMP) 1 3 - PRESSURE AT PROXIMAL POSTERIOR AREA FROM TROCHANTER 4- THE WIDTH OF THE ISCHIAL SEAT = 25 mm 105° SAGITAL PLANE IS PARALLEL TO THE LINE OF PROGRESSION 18 mm 25 mm 2 105° 3 90 ° INITIAL FLEXION = 5° (MEDIUM STUMP) 4