Surgical Technique; Preoperative Planning; Patient Positioning; Reduction - Zimmer Biomet Zimmer Natural Nail Manual

4 | Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical Technique

Surgical Technique

Preoperative Planning

Preoperative planning is recommended before
beginning the surgical procedure. A/P and Lateral
X-rays of the injured femur should be taken
preoperatively and evaluated for length, canal
size and implant suitability. A/P and Lateral X-rays
of the contralateral uninjured femur can also be
taken preoperatively to provide insight into the
characteristics of the pre-injured femur.

Patient Positioning

Patients can be positioned either supine or in a
lateral decubitus position. As the C-arm will be
used during the procedure, care should be taken
to orient the patient to allow for A/P and Lateral
imaging of the proximal femur, the fracture and
the distal femur. The use of a fracture table can be
beneficial in helping to reduce fractures as well as
to facilitate intraoperative imaging with a C-arm.
The patient should be positioned to allow for easy
access to the greater trochanter of the femur with
instrumentation. Adduction of the affected leg can
also be helpful, especially in the supine position.
Drape the patient appropriately to allow the
surgeon to work around the hip and full length of
the femur (to the knee).

Reduction

It is critical to achieve anatomic reduction before
beginning any of the steps to place the intramedullary
nail. Traction should be used as necessary to help
achieve fracture reduction. Several instruments are
available to assist in fracture reduction including
clamps, hemostatic forceps, ball spike pushers and
Steinmann pins.