Zimmer Biomet Zimmer Natural Nail Manual
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Zimmer Biomet Zimmer Natural Nail Manual

Cephalomedullary asia nail, surgical technique
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Natural Nail
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Cephalomedullary Asia Nail
Surgical Technique

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Summary of Contents for Zimmer Biomet Zimmer Natural Nail

  • Page 1 Zimmer ® Natural Nail System ® Cephalomedullary Asia Nail Surgical Technique...

  • Page 3: Table Of Contents

    Table of Contents Product Overview ..................... 2 Implant Overview ..................... 2 Indications ........................ 3 Contraindications ..................... 3 Surgical Technique ....................4 Preoperative Planning ....................4 Patient Positioning ..................... 4 Reduction ........................4 Starting Point Location ....................5 Proximal Reaming ....................... 8 Shaft Reaming ......................

  • Page 4: Product Overview

    Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical Technique Product Overview Implant Overview Nail Diameters: The Zimmer Natural Nail System is a system of intramedullary nails, screws, instruments and other Asia: 9.3, 10, 11.5, 13, 14.5 mm associated implants that are designed to provide Long: 10, 11.5, 13 mm...

  • Page 5: Indications

    Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical Technique Indications Contraindications The Zimmer Natural Nail System is intended for • A medullary canal obliterated by a previous temporary fracture fixation and stabilization of the fracture or tumor bone. • Bone shaft having excessive bow or deformity Indications for the Cephalomedullary Asia and Long •...

  • Page 6: Surgical Technique

    Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical Technique Surgical Technique Preoperative Planning Preoperative planning is recommended before The patient should be positioned to allow for easy beginning the surgical procedure. A/P and Lateral access to the greater trochanter of the femur with X-rays of the injured femur should be taken instrumentation.

  • Page 7: Starting Point Location

    Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical Technique Figure 1 Starting Point Location Palpate the greater trochanter manually. Incise the Use the C-arm to visualize the pin’s position from skin starting about 2 cm proximal to the tip of the an A/P and Lateral view.
  • Page 8 Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical Technique Figure 2 Figure 3 Starting Point Location (cont.) Drive the pin through the tip of the greater trochanter Alternatively, a cannulated awl can be used to down to the level of the lesser trochanter. Remove find the entry point and create the entry portal the starting point locator from the entry cannula.
  • Page 9 Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical Technique Figure 4 Figure 5 Starting Point Location (cont.) Place a 3.0 mm x 100 cm ball tip guide wire or If you plan to ream the canal of the femur, the guide...

  • Page 10: Proximal Reaming

    Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical Technique Figure 6 Figure 7 Starting Point Location (cont.) Proximal Reaming A reduction finger is included in the set. The guide Use the 15.5 mm taper reamer (blue) to prepare the wire can be fed retrograde through the reduction proximal femur for the proximal portion of the nail finger.

  • Page 11: Shaft Reaming

    Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical Technique Figure 8 Shaft Reaming Implant Selection Reaming should be performed through the entry The diameter and length of the nail have already cannula. To reduce risk of enlarging the entry hole been determined (using nail length gauge and last laterally push the entry cannula medially.

  • Page 12: Nail Assembly And Insertion

    10 | Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical Technique Figure 9 Figure 10 Figure 11 Nail Assembly and Insertion The color code for the Cephalomedullary Nail is Begin threading the connecting bolt (by hand or blue. Ti-6Al-4V alloy nails, the targeting guide and...
  • Page 13 Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical Technique 11 | Figure 12 Nail Assembly and Insertion (cont.) Lay the guide attached to the nail over the femur. DY holes, care must be taken to ensure that the Confirm that the bow of the nail is anterior similar to correct ST/DY holes will be used for the surgery the bow of the femur.
  • Page 14 12 | Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical Technique Figure 13 Figure 14 Nail Assembly and Insertion (cont.) If the nail does not pass down the canal easily, Anteversion can be checked by pushing pins attach the impaction head to the targeting guide.

  • Page 15: Lag Screw Placement

    Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical Technique 13 | Instrument Type Asia Double Cannula Pink-Pink Drill Sleeve (Optional) 4.3 mm Pink-Pink-Red Lag Screw Cannula Pink-Pink 3.2 mm Lag Screw Pin Sleeve Pink-Pink Lag Screw Reamer Pink-Pink Lag Screw Tap...
  • Page 16 14 | Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical Technique Figure 15 Figure 16 Lag Screw Placement (cont.) Assemble the lag screw trocar into the lag screw fluoroscopy, drill the 3.2 mm pin to the level of cannula and pass through the correct hole in the the subchondral bone of the femoral head without targeting guide for the chosen CCD angle.
  • Page 17 Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical Technique 15 | Figure 17 Figure 19 Figure 18 Lag Screw Placement (cont.) If it is desired to utilize an antirotation pin to assist Alternatively, the pin can be placed using a freehand...
  • Page 18 16 | Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical Technique Figure 20 Figure 21 Figure 22 Lag Screw Placement (cont.) Remove the 3.2 mm lag screw pin sleeve from the Slide the lag screw stop assembly onto the lag screw lag screw cannula.
  • Page 19 Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical Technique 17 | Figure 23 Figure 24 Lag Screw Placement (cont.) Attach the lag screw reamer to the drill. Ream over The lag screw is self tapping. If preferred, tap the the 3.2 mm pin to the level of the subchondral hole for the lag screw over the guide pin by hand bone (Figure 23).
  • Page 20 18 | Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical Technique Figure 25 Figure 26 Lag Screw Placement (cont.) If compression is planned, thread the compression Insert the lag screw over the 3.2 mm pin and into device onto the lag screw inserter and twist it to the the femur (Figure 26).
  • Page 21 Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical Technique 19 | Figure 27 Figure 28 Lag Screw Placement (cont.) Rotate the lag screw inserter up to 90° in order to If compression is desired, twist the compression correctly orient the handle to the guide (Figure 27).
  • Page 22 20 | Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical Technique Figure 30 Figure 29 Figure 31 Lag Screw Placement (cont.) As the device presses against the lag screw cannula, A set screw (included in the lag screw package it will generate compression across the fracture or packaged separately) must be used to prevent (Figure 29).
  • Page 23 Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical Technique 21 | Figure 32 Figure 33 Lag Screw Placement (cont.) Note: If using the flexible captured set screw Note: To achieve sliding, tighten the set screw and driver make sure that it is not used at an angle then rotate the set screw inserter counterclockwise greater than 40°.

  • Page 24: Distal Targeting For Asia Nails

    22 | Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical Technique Instrument Type Asia Guide 8.0 mm Screw Cannula Orange–Orange 4.3 mm Drill Sleeve Orange–Orange–Red 4.3 mm Drill Bit Orange–Orange–Red Screwdriver Orange–Orange Screw Depth Gauge Orange Distal Targeting For Asia Nails Color coded instruments are also used for distal distal hole or slot.
  • Page 25 Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical Technique 23 | Figure 34 Distal Targeting For Asia Nails (cont.) The nail utilizes a 5.0 mm screw distally. The screw Caution: Do not drive the screws into the bone packages are labeled with the color red. The distal...

  • Page 26: Freehand Technique For Long Nails

    24 | Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical Technique Figure 35 Freehand Technique for Long Nails Insert the free hand 4.3 mm drill bit (red) into the Remove the drill bit. Measure the depth of the hole distal targeting device. Finger tighten the set screw.

  • Page 27: Final Implant Placement

    Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical Technique 25 | Figure 36 Final Implant Placement Observe the depth of the nail in the proximal femur. Choose the appropriate height of nail cap. Secure Ridges at 5 and 10 mm from the end of the targeting the selected nail cap to the flexible nail cap inserter guide barrel indicate nail depth.

  • Page 28: Postoperative Care

    26 | Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical Technique Postoperative Care Early range of motion exercises of the knee and ankle To remove the nail, slide a 2.0 mm pin through are encouraged. Allow toe-touch weight bearing the nail. Insert the cephalomedullary cannulated...

  • Page 30: Cephalomedullary Asia Nail Details

    28 | Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical Technique Cephalomedullary Asia Nail Details 15° Anteversion 4° Proximal Lateralization Angle 15.5 mm Proximal Head Blue Ring 35 to 39 mm from tip (3.0 mm Pin) 58 mm Proximal 42 to 54 mm from tip (10.5 mm Lag Screw) Body Length 125°/130°...

  • Page 31: Cephalomedullary Long Nail Details

    Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical Technique 29 | Cephalomedullary Long Nail Details 15° Anteversion 4° Proximal Lateralization Angle 15.5 mm Proximal Head Blue Ring 35 to 39 mm from tip (3.0 mm Pin) 58 mm Proximal 42 to 54 mm from tip (10.5 mm Lag Screw) Body Length 125°/130°...

  • Page 32: Product Information

    30 | Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical Technique Product Information Cephalomedullary Asia Nails Cephalomedullary Long Nails Item Number Product Description Item Number Product Description 47-2493-180-09 Cephalomedullary Asia Nail 9.3 mm X 18 cm 47-2493-300-10 Cephalomedullary Long Nail 10 mm X 30 cm...
  • Page 33 Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical Technique 31 | Cephalomedullary Long Nails (cont.) Item Number Product Description Item Number Product Description 47-2493-420-10 Cephalomedullary Long Nail 10 mm X 42 cm 47-2493-360-11 Cephalomedullary Long Nail 11.5 mm X 36 cm...
  • Page 34 32 | Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical Technique Cephalomedullary Long Nails (cont.) Item Number Product Description Item Number Product Description 47-2493-300-13 Cephalomedullary Long Nail 13 mm X 30 cm 47-2493-420-13 Cephalomedullary Long Nail 13 mm X 42 cm...
  • Page 35 Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical Technique 33 | 10.5 mm Lag Screws Item Number Product Description Item Number Product Description 47-2485-070-10 10.5mm Lag Screw 70 mm Length 47-2483-040-50 5.0 mm Cortical Screw 40 mm Length Ti-6Al-4V Ti-6Al-4V Alloy Alloy Partially Threaded 3.5 mm Hex Head...
  • Page 36 34 | Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical Technique 5.0 mm Screws (for distal screw holes) Nail Caps / Set Screw (cont.) Item Number Product Description Item Number Product Description 47-2484-032-50 5.0 mm Cortical Screw 32.5 mm Length Ti- 6Al-4V...
  • Page 37 Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical Technique 35 | KT-2490-003-06 – Asia Cephalomedullary Nail Instrument Set Item Number Product Description Item Number Product Description 00-2490-000-30 Nail Diameter Gauge 00-2490-032-15 Cephalomedullary Impaction Head - Asia 1 00-2490-032-20 Cephalomedullary Slap Hammer...
  • Page 38 36 | Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical Technique Ball Tip Guide Wire Sterile Instruments (available separately) Item Number Product Description Item Number Product Description 47-2490-375-32 3.2 mm Threaded Pin L. 375 mm 00-2255-008-01 3.0 mm Ball Tip Guide Wire 100 cm 47-2490-046-43 Cephalomedullary Calibrated Drill 4.3 mm - Asia...
  • Page 40 38 | Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical Technique Notes...
  • Page 42 All content herein is protected by copyright, trademarks and other intellectual property rights, as applicable, owned by or licensed to Zimmer Biomet or its affiliates unless otherwise indicated, and must not be redistributed, duplicated or disclosed, in whole or in part, without the express written consent of Zimmer Biomet.

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