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Figure 2. UCLA CAT-CAM medial-lateral diameter measurements. 2 Figure 3. Ilio-femoral angle, as measured UCLA CAT-CAM. 2 for At this point I will briefly review the highlights of the UCLA CAT-CAM sequence, beginning with patient evaluation and measurement and proceeding through model modification and bench alignment. For the details, I suggest referencing the third edition of the UCLA manual. The recommended evaluation/measurement protocol is very complete and detailed, covering many of the procedures with which we should all be familiar. Adduction and flexion analysis of the residual limb are emphasized. Some new measurements and/or evaluations are introduced and illustrated: • Skeletal ML dimension, actually measured on patient (Figure 2) • Soft tissue ML dimension, taken from Ivan Long's chart of circumferences and related ML values (Figure 2) • Ilio-femoral angle, actually measured on the patient (Figure 3) • Public arch angle, evaluated by palpation and captured in the wrap cast (Figure 4) • Ischial inclination, evaluated by palpation and captured in the wrap cast (Figure 5) The wrap cast is taken with the patient in a standing position, and all shaping of the cast is accomplished by hand molding. The goal is good definition and containment of the medial and posterior aspects of the ischial tuberosity and ischial ramus within the wrap cast and subsequent socket, as well as allowance for the pubic ramus to exit the socket near the midline of the medial wall (Figure 6). The initial trimlines for the resultant socket are as follows: 1. Anteriorly, just proximal to the inguinal crease. The anterolateral brim must clear the superior iliac spine when the patient is sitting. 2. Laterally, the brim extends approximately 3" above the trochanter. The final height of this wall will be determined during fitting. 3. Posteriorly, the trim line should begin at least 1" above the level of the inferior border of the ischial tuberosity. The curve that defines the posterior to lateral trim line normally begins at a point between the lateral third and the midline of the socket ML dimension at ischial level.
Figure 4. The pubic arch angle, as evaluated for UCLA CAT-CAM. 2 Figure 5. The ischial inclination angle, as evaluated for UCLA CAT-CAM. 2 Figure 6. Medial view of pelvis-socket relationship, UCLA CAT-CAM. 2 4. The medial proximal brim will be "V" shaped, with the vortex of the "V" located at the point where the pubic ramus crosses the medial wall. This trim line projects upward from the vortex, posteriorly to encapsulate the medial aspect of the ischial ramus and tuberosity. (Figure 6) A circumference reduction chart is used to attain suction suspension. The values used in this chart are slightly less than those normally used in quadrilateral suction sockets.
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