Zimmer Biomet Zimmer Natural Nail, Руководство пользователя

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26 | Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical Technique
Postoperative Care
Early range of motion exercises of the knee and ankle
are encouraged. Allow toe-touch weight bearing
to progress to full weight bearing as fracture callus
increases on the x-ray films.*
Nail Extraction
Use the C-arm to locate any distal screws. Remove
the screws using a 3.5 mm hex screwdriver. Remove
the nail cap with a standard 5.0 mm hex screwdriver.
Use a 3.5 mm hex screwdriver to remove the set
screw. Expose the lag screw and use the lag screw
inserter to remove it.
Note: To remove the lag screw it is not necessary
that the set screw is completely removed. Turn
the set screw two turns backwards and make
sure that the set screw is still engaged in the
threads of the nail.
Note:
It is recommended to use the lag screw
cannula as a guidance for the lag screw inserter
while removing the lag screw. Assemble the lag
screw inserter through the lag screw cannula
into the lag screw. Use the compression device
to push the lag screw cannula to the bone. Make
sure that the lag screw inserter is fully seated.
Hand tighten the lag screw retaining shaft with a
3.5 mm hex screwdriver.
To remove the nail, slide a 2.0 mm pin through
the nail. Insert the cephalomedullary cannulated
extraction adapter over the pin into the top of
the nail. Tighten the adapter to the nail. Attach a
slaphammer or other impaction device and impact
to back out the nail. The nail should move with each
impaction. Periodically retighten the adapter and/
or slaphammer 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 cephalomedullary lag screw extraction
device should then be engaged and rotated in
a counter-clockwise motion into the exposed
lateral threads of the cephalomedullary lag screw
that is being explanted. The rotation direction is
counter-clockwise as the cephalomedullary lag
screw extraction device utilizes reverse-cutting
flutes to enable mating to the cephalomedullary
lag screw. While rotating, a constant axial force
must be applied to maintain the tool driving into
the cephalomedullary lag screw thread. While
continuing to rotate the cephalomedullary lag
screw extraction device counter-clockwise, the
cephalomedullary lag screw that is being explanted
will unseat from the bone and can be removed.
*It may be necessary to consider a postoperative treatment course that reduces the stress on the nail system. Full unassisted load bearing should never take place until fracture
callus formation is visualized on X-ray. Close supervision of the patient is advised to ensure the patient’s cooperation until bony union is achieved. After healing occurs, these
devices serve no functional purpose and should be removed. Continued surveillance for new or recurrent infection should be continued as long as the device is in place. Device
removal should be followed by adequate postoperative management to avoid refractor.