Proximal Reaming - Zimmer Biomet Zimmer Natural Nail Manual

8 | Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical Technique
Starting Point Location (cont.)
A reduction finger is included in the set. The guide
wire can be fed retrograde through the reduction
finger. The reduction finger can then be placed into
the femur and used to help reduce the femur from
the inside as well as to help facilitate passage of the
guide wire past the fracture site.
If a long nail is to be implanted, assemble the two
piece nail length gauge. This step can be skipped
if using an Asia nail (18 cm in length). Slide the tube
portion of the gauge over the 3.0 mm x 100 cm
guide wire until the tip of the tube is at the level of
the tip of the greater trochanter (confirm position
using fluoroscopy) (Figure 6). The proximal end of
the guide wire indicates the length of the wire in the
canal. When determining nail length, consideration
should be taken as to how deep the nail will be
inserted into the femur based upon the shape of
the patient's proximal femur. A ruler is also included
in the set which can be used to radiographically
determine nail length.
Figure 6 Figure 7

Proximal Reaming

Use the 15.5 mm taper reamer (blue) to prepare the
proximal femur for the proximal portion of the nail
(Figure 7). The C-arm should be used to visualize the
depth of the reamer in the proximal femur.
Technique Tip: For smaller Asian anatomy the
proximal reaming should be done until the tip
of the 15.5 mm taper reamer reaches the level of
the lesser trochanter.
Care should be taken to keep the reamer in line with
the shaft of the femur to avoid reaming through the
medial cortex of the femur.
The 15.5 mm taper reamer has three grooves on
it. The most proximal groove indicates the final
position of the top of the nail. The two distal grooves
help visualize the placement of the lag screw.
Visualizing a line between these grooves on each
side of the reamer (under fluoroscopic visualization)
will indicate where a 130 degree CCD angle lag
screw would be placed in the femoral neck and
head.