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Zimmer

®

Natural Nail

®

System

Cephalomedullary Asia Nail

Surgical Technique

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Summary of Contents for Zimmer Natural Nail

Page 1: ...Zimmer Natural Nail System Cephalomedullary Asia Nail Surgical Technique ...

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Page 3: ...tarting Point Location 5 Proximal Reaming 8 Shaft Reaming 9 Implant Selection 9 Nail Assembly and Insertion 10 Lag Screw Placement 13 Distal Targeting For Asia Nails 22 Freehand Technique for Long Nails 24 Final Implant Placement 25 Postoperative Care 26 Nail Extraction 26 Cephalomedullary Asia Nail Details 28 Cephalomedullary Long Nail Details 29 Product Information 30 ...

Page 4: ...e nail distally to further secure the implant in place and maintain length and alignment while healing occurs A choice of Asia and long nails as well as nails of different diameters and centercolumn diaphyseal CCD angles are available to best match the individual anatomy of the patient Implant Overview Nail Diameters Asia 9 3 10 11 5 13 14 5 mm Long 10 11 5 13 mm Nail Lengths Asia 18 cm Long 30 to...

Page 5: ...d union Periprosthetic fractures Surgically created defects such as osteotomies Intertrochanteric and subtrochanteric fractures Contraindications A medullary canal obliterated by a previous fracture or tumor Bone shaft having excessive bow or deformity Lack of bone substance or bone quality which makes stable seating of the implant impossible All concomitant diseases that can impair the functionin...

Page 6: ...ral 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 p...

Page 7: ...o visualize the pin s position from an A P and Lateral view The pin should be inserted at the tip of the greater trochanter in the posterior portion of the middle third of the trochanter The pin should not be on the lateral portion of the greater trochanter it must be on the tip A starting point slightly medial to the tip of the trochanter is also acceptable Note A starting point lateral to the ti...

Page 8: ...t locator from the entry cannula Use the 8 mm entry reamer to ream an entry portal into the proximal femur through the starting point on the tip of the greater trochanter Figure 2 Remove the reamer and 3 0 mm pin Alternatively a cannulated awl can be used to find the entry point and create the entry portal Figure 3 Widening of fracture side and varus tilting of the proximal fragment should be avoi...

Page 9: ... If the guide wire is bent shorter than 5 cm from the end of the wire and or more than 10 degrees it may be difficult to remove from the nail If the wire becomes lodged inside the nail utilize the guide wire gripper and mallet to remove the guide wire from the nail If you plan to ream the canal of the femur the guide wire should be embedded in the distal femur at the level of the distal epiphyseal...

Page 10: ...130 degree CCD angle lag screw would be placed in the femoral neck and head 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 ...

Page 11: ...l 18 cm of the canal If a long nail is planned ream the full length of the canal The guide wire pusher can help prevent the ball tip guide wire from coming out of the femur during reaming Note If the guide wire becomes lodged within the reamer use the guide wire pusher to push the guide wire back into the intramedullary canal Implant Selection The diameter and length of the nail have already been ...

Page 12: ... guide The arrow on the nail with an R for a Right Nail or an L for a Left Nail will line up with the arrow on the barrel of the guide when the nail is correctly aligned Figure 9 Begin threading the connecting bolt by hand or using the connecting bolt inserter into the proximal portion of the nail Orient the proximal portion of the nail so that the slots in the nail match up with the corresponding...

Page 13: ...ng the hole indicators to help ensure that they stay in place Warning The targeting guide Asia is designed to target the transverse distal static ST and dynamic DY holes in Asia nails As the guide is designed to work with both left and right ST and DY holes care must be taken to ensure that the correct ST DY holes will be used for the surgery use the left holes when using a left nail and vice vers...

Page 14: ...ting guide as this may break the guide or cause it to lose its accuracy especially when locking mechanism is in the locked position If the nail will not advance with impaction remove the nail and ream the canal to a larger diameter at additional 0 5 mm increments or consider using a smaller diameter nail Anteversion can be checked by pushing pins through the small holes proximal to the barrel Figu...

Page 15: ...s of the tip of the lag screw to the apex of the femoral head in the A P and Lateral x ray views has been shown to be a key indicator in reducing cut out of lag screws in the femoral head The TAD should be less than 25 mm 1 Position the targeting guide so that the trajectory of the lag screw cannula will place the lag screw in the appropriate position in the femoral head and neck Pins can be held ...

Page 16: ...y by visualizing a line extending from the center of the cannula into the femoral head Remove the trocar and insert the 3 2 mm lag screw pin sleeve Insert a 3 2 mm pin through the pin sleeve Under Figure 15 Figure 16 fluoroscopy drill the 3 2 mm pin to the level of the subchondral bone of the femoral head without penetrating the femoral cortex Figure 16 Assess the position of the pin using the C a...

Page 17: ...argeting Position the antirotationpinslightlyproximaltothecenter line of the femoral neck Figure 17 and 18 Alternatively the pin can be placed using a freehand technique anterior to the nail and into the femoral neck and head 2 3 Further antirotation pins can be placed along the nail Insert the antirotation pin sleeve into the corresponding hole of the targeting guide Both sleeve and hole are colo...

Page 18: ...al cortex of the femur using fluoroscopy to accurately determine the length of the lag screw to be used The end of the guide pin in the depth gauge indicates the length of the lag screw to be used Slide the lag screw stop assembly onto the lag screw reamer Figure 21 Place the window in the stop over the number measured with the cannulated depth gauge Figure 22 If the measurement was between markin...

Page 19: ...e reamer Push the end of the 3 2 mm pin while withdrawing the power tool The lag screw is self tapping If preferred tap the hole for the lag screw over the guide pin by hand using the T handle The stop can be used to indicate the appropriate depth to tap Select the appropriate lag screw length based on previous measurements The screw depth gauge can also be used to verify the length of lag screw t...

Page 20: ... it to the level of the handle Figure 25 This may be done before or after attaching the lag screw Insert the lag screw over the 3 2 mm pin and into the femur Figure 26 Confirm placement using the C arm The handle on the lag screw inserter must be parallel or perpendicular to the axis of the guide indicated by colored dots between the holes for the lag screw cannulas Figure 25 Figure 26 ...

Page 21: ... overtighten the lag screw The distal edge must protrude laterally through the femur to ensure that sliding can occur Technique Tip If using an antirotation pin through the nail position the T handle per pendicular to the guide This reduces the risk of interference when removing the antirota tion pin If compression is desired twist the compression device in a clockwise fashion Figure 28 Figure 27 ...

Page 22: ...ncluded in the lag screw package or packaged separately must be used to prevent the lag screw from rotating post operatively Insert the tip of the fully flexible set screw inserter or 3 5 mm hex screwdriver into the 3 5 mm hex end of the set screw Figure 30 The set screw is then passed through the connecting bolt into the proximal portion of the nail Figure 31 Note Do not drive the set screw into ...

Page 23: ...ted using a reasonable amount of force the construct is in the correct position If rotation is possible adjust the position of the lag screw rotate slightly so that the set screw can enter the groove in the lag screw Figure 32 Note Toachievesliding tightenthesetscrewand thenrotatethesetscrewinsertercounterclockwise one quarter turn Do not unscrew the set screw more than one quarter turn Make sure ...

Page 24: ...mble the 4 3 mm drill sleeve to the 8 0 mm screw cannula Pass the cannula through the appropriate hole in the targeting guide to target the 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 hole or slot The hole is labeled ST is for the Static Hole The hole...

Page 25: ... long nails only Choose the appropriate length screw based on the depth gauge or drill bit reading Use the 3 5 mm hex screwdriver to place the screw bicortically through the bone If using the captured screwdriver place the appropriate screw on the 3 5 mm hex and tighten the screw to the captured screwdriver by turning the knob next to the handle clockwise Caution Do not drive the screws into the b...

Page 26: ...e drill bit into the bone using the mallet Remove the distal targeting device Slide the free hand tissue protection sleeve over the drill bit Attach the drill to the free hand 4 3 mm drill bit and advance the drill bit through the bone Verify that the drill bit has gone through the hole in the nail Remove the drill bit Measure the depth of the hole using the free hand screw depth gauge Insert the ...

Page 27: ...f a nail cap will not be used do not introduce the 2 0 mm pin Technique Tip The 0 mm height nail cap can be placed through the targeting guide following removal of the connecting bolt Other nail caps cannot be placed until the targeting guide is also removed Figure 36 Choose the appropriate height of nail cap Secure the selected nail cap to the flexible nail cap inserter using the flexible nail ca...

Page 28: ...aphammer during extraction as needed The nail may rotate as it passes through the canal during extraction If a secondary option is needed to remove the lag screw the cephalomedullary lag screw extraction device can be used To use the cephalomedullary lag screw extraction device align its axis with the axis of the cephalomedullary lag screw that is being explanted The conical thread of the cephalom...

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Page 30: ...mm Screws Clothespin tip for nails 11 5 mm in diameter and larger Note There is no locking tap StabiliZe Technology for Cephalomedullary Asia nails 125 130 CCD angle 58 mm Proximal Body Length 1275 mm Anterior Bow Radius 9 3 10 11 5 13 14 5 mm shaft diameters Lag Screw 10 5 mm Diameter 6 6 mm Minor Diameter 10 2 mm Drill 2 8 mm Tip Length 5 0 mm Screw 8 mm Diameter Head 3 8 mm Head Height 4 3 mm M...

Page 31: ...0 mm from tip Anterior bevel on tip 125 130 CCD angle 58 mm Proximal Body Length 1275 mm Anterior Bow Radius Lengths 30 through 34 cm 1400 mm Anterior Bow Radius Lengths 36 through 40 cm 1525 mm Anterior Bow Radius Lengths 42 through 46 cm 10 11 5 13 mm shaft diameters Spiral Flutes Lag Screw 10 5 mm Diameter 6 6 mm Minor Diameter 10 2 mm Drill 2 8 mm Tip Length 5 0 mm Screw 8 mm Diameter Head 3 8...

Page 32: ...mber Product Description 47 2493 300 10 Cephalomedullary Long Nail 10 mm X 30 cm 125 CCD Right Ti 6Al 4V Alloy 47 2493 301 10 Cephalomedullary Long Nail 10 mm X 30 cm 125 CCD Left Ti 6Al 4V Alloy 47 2493 302 10 Cephalomedullary Long Nail 10 mm X 30 cm 130 CCD Right Ti 6Al 4V Alloy 47 2493 303 10 Cephalomedullary Long Nail 10 mm X 30 cm 130 CCD Left Ti 6Al 4V Alloy 47 2493 320 10 Cephalomedullary L...

Page 33: ...g Nail 11 5 mm X 34 cm 130 CCD Right Ti 6Al 4V Alloy 47 2493 343 11 Cephalomedullary Long Nail 11 5 mm X 34 cm 130 CCD Left Ti 6Al 4V Alloy Item Number Product Description 47 2493 360 11 Cephalomedullary Long Nail 11 5 mm X 36 cm 125 CCD Right Ti 6Al 4V Alloy 47 2493 361 11 Cephalomedullary Long Nail 11 5 mm X 36 cm 125 CCD Left Ti 6Al 4V Alloy 47 2493 362 11 Cephalomedullary Long Nail 11 5 mm X 3...

Page 34: ...alomedullary Long Nail 13 mm X 38 cm 125 CCD Right Ti 6Al 4V Alloy 47 2493 381 13 Cephalomedullary Long Nail 13 mm X 38 cm 125 CCD Left Ti 6Al 4V Alloy 47 2493 382 13 Cephalomedullary Long Nail 13 mm X 38 cm 130 CCD Right Ti 6Al 4V Alloy 47 2493 383 13 Cephalomedullary Long Nail 13 mm X 38 cm 130 CCD Left Ti 6Al 4V Alloy 47 2493 400 13 Cephalomedullary Long Nail 13 mm X 40 cm 125 CCD Right Ti 6Al ...

Page 35: ...ical Screw 42 5 mm Length Ti 6Al 4V Alloy Partially Threaded 3 5 mm Hex Head 47 2483 045 50 5 0 mm Cortical Screw 45 mm Length Ti 6Al 4V Alloy Partially Threaded 3 5 mm Hex Head 47 2483 047 50 5 0 mm Cortical Screw 47 5 mm Length Ti 6Al 4V Alloy Partially Threaded 3 5 mm Hex Head 47 2483 050 50 5 0 mm Cortical Screw 50 mm Length Ti 6Al 4V Alloy Partially Threaded 3 5 mm Hex Head 47 2483 052 50 5 0...

Page 36: ... Angle 3 5 mm Hex Head 47 2484 060 50 5 0 mm Cortical Screw 60 mm Length Ti 6Al 4V Alloy Fixed Angle 3 5 mm Hex Head 47 2484 065 50 5 0 mm Cortical Screw 65 mm Length Ti 6Al 4V Alloy Fixed Angle 3 5 mm Hex Head 47 2484 070 50 5 0 mm Cortical Screw 70 mm Length Ti 6Al 4V Alloy Fixed Angle 3 5 mm Hex Head 47 2484 075 50 5 0 mm Cortical Screw 75 mm Length Ti 6Al 4V Alloy Fixed Angle 3 5 mm Hex Head 4...

Page 37: ...00 2490 003 70 Cephalomedullary Cannulated Screw Depth Gauge Asia 1 Item Number Product Description Qty 00 2490 032 15 Cephalomedullary Impaction Head Asia 1 00 2490 032 20 Cephalomedullary Slap Hammer Adapter Asia 1 00 2490 040 90 Cephalomedullary Double Cannula Asia 1 00 2490 041 08 Cephalomedullary Connecting Bolt Inserter 8 mm Asia 1 00 2490 046 20 2 0 mm Pin 2 00 2490 046 32 Guide Pin Inserte...

Page 38: ...00 2490 090 12 Cephalomedullary Lag Screw Extraction Device Cases Item Number Product Description Qty 00 2490 046 00 Cephalomedullary Asia Case 1 Of 2 Stainless Steel 1 00 2490 047 00 Cephalomedullary Asia Case 2 Of 2 Stainless Steel 1 Tear Drop Guide Wire available separately Item Number Product Description 47 2490 097 00 3 0 mm x 100 cm Tear Drop Guide Wire sterile 47 2490 097 01 2 4 mm x 100 cm...

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Page 40: ...38 Zimmer Natural Nail Cephalomedullary Asia Nail Surgical Technique Notes ...

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Page 42: ... surgeon Rx only 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 Distribution to any other recipient is prohibited For product in...

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