Zimmer Biomet Zimmer Natural Nail Manual

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Zimmer Biomet Zimmer Natural Nail Manual Manual pdf 10 page image

8 | Zimmer Natural Nail – Cephalomedullary Asia Nail Surgical TechniqueProximal ReamingUse the 15.5 mm taper reamer (blue) to prepare theproximal femur for the proximal portion of the nail(Figure 7). The C-arm should be used to visualize thedepth of the reamer in the proximal femur.Technique Tip: For smaller Asian anatomy theproximal reaming should be done until the tipof the 15.5 mm taper reamer reaches the level ofthe lesser trochanter.Care should be taken to keep the reamer in line withthe shaft of the femur to avoid reaming through themedial cortex of the femur.The 15.5 mm taper reamer has three grooves onit. The most proximal groove indicates the finalposition of the top of the nail. The two distal grooveshelp visualize the placement of the lag screw.Visualizing a line between these grooves on eachside of the reamer (under fluoroscopic visualization)will indicate where a 130 degree CCD angle lagscrew would be placed in the femoral neck andhead.Starting Point Location (cont.)A reduction finger is included in the set. The guidewire can be fed retrograde through the reductionfinger. The reduction finger can then be placed intothe femur and used to help reduce the femur fromthe inside as well as to help facilitate passage of theguide wire past the fracture site.If a long nail is to be implanted, assemble the twopiece nail length gauge. This step can be skippedif using an Asia nail (18 cm in length). Slide the tubeportion of the gauge over the 3.0 mm x 100 cmguide wire until the tip of the tube is at the level ofthe tip of the greater trochanter (confirm positionusing fluoroscopy) (Figure 6). The proximal end ofthe guide wire indicates the length of the wire in thecanal. When determining nail length, considerationshould be taken as to how deep the nail will beinserted into the femur based upon the shape ofthe patient’s proximal femur. A ruler is also includedin the set which can be used to radiographicallydetermine nail length.Figure 6 Figure 7