M/DN® Femoral Retrograde Intramedullary Fixation Surgical Technique Mdn

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M/DN® Femoral

Retrograde

Intramedullary

Fixation

Surgical Technique

M/DN® Femoral Retrograde Intramedullary Fixation 1

Surgical Techniques

for Fixation of Fractures

with an M/DN Femoral

Retrograde Nail

Table of Contents

Surgical Technique for the M/DN

Femoral Retrograde Nail Fixation 2

Introduction 2

Indications 2

Preoperative Planning 2

Patient Positioning and Radiographic Control 3

Reduction 3

Incision and Exposure 3

Creating the Entry Portal 4

Guide Wire Placement and Reaming 5

Nail Insertion 7

Distal Locking 9

Proximal Locking 12

Technique for Using the Free-Hand Targeting Device 12

End Cap Placement 14

Closure and Postoperative Care 14

Extraction 14

Instrument Case Options 15

M/DN® Femoral Retrograde Intramedullary Fixation

2

Surgical Technique

for the M/DN Femoral

Retrograde Nail Fixation

Introduction

Retrograde femoral nailing is an

alternate technique for the treatment

of femoral fractures utilizing an

intramedullary nail that is similar to but

modified from a standard antegrade

femoral nail. The M/DN® Femoral

Retrograde Nail is designed for distal

fixation and anterior to posterior

proximal fixation. The nail is available

in six diameters ranging from 9mm to

14mm and lengths from 14cm to 48cm

in 2cm increments. The distal end of

the retrograde femoral nail is 12mm in

diameter for nail sizes 9-12mm.

Indications

A. Fractures without

Extensive Comminution

B. Fractures Involving the

Femoral Condyles that Require Open

Knee Access

C. Intertrochanteric Femoral

Shaft Fractures

D. Femoral Shaft Fractures with

Attendant Femoral Neck Fractures

(Nail to be used in conjection with

fixation screws or plates as needed)

E. Ipsilateral Femorotibial Fractures

(“Floating Knee” Fractures)

F. Distal Fractures Involving

Osteoporotic Bone

G. Closed Supracondylar Fractures

H. Nonunions or Pseudoarthroses

I. Malunions

J. Pathological Fractures

K. T-condylar Fractures

L. Severely Comminuted

Supracondylar Fractures with

Articular Involvement

M. Femoral Shaft Fractures

N. Ipsilateral Patellofemoral Fractures

O. Bilateral Femoral Shaft Fractures

Preoperative Planning

Proper preoperative planning is

essential to successful retrograde

nailing of the femur. To determine the

appropriate nail size, an ossimeter,

roentgenogram templates, and an x-ray

film of the unaffected extremity are

necessary for determining canal size

at the isthmus and for measuring

the length of the femur to aid in

determining nail length.

The Nail Length Gauge or Harris/

Galante Bulb-Tip (Sounds), available in

diameters from 10mm to 17mm, can

be used as alternate techniques to

determine nail diameter and length.

X-rays taken at a 36-inch distance

from the x-ray source result in 10-15

percent magnification of bone. The

ossimeter has both an actual size

scale and one that takes into account

this magnification. It should be used

routinely to determine nail diameter

and length.

The proper length of the nail should

extend from 5mm-7mm above the

intercondylar notch, proximal to the

superior border of the lesser trochanter.

The diameter of the femoral nail should

match the isthmus in the lateral x-ray

projection or the canal reamed to

accept the desired nail size.

The surgeon should review the x-ray

to assure that there are no unusual

anatomic variations.

M/DN® Femoral Retrograde Intramedullary Fixation 3

Fig. 1

Patient Positioning and

Radiographic Control

Place the patient in the supine

position (Fig. 1) with the knee flexed

approximately 30 degrees. Prep the hip

to the iliac crest to ensure access to the

lesser trochanter.

The use of image intensification

is required. The image intensifier

should be sterile-draped and may be

positioned from either the contralateral

or ipsilateral side of the operating

table. Positioning from the contralateral

side will facilitate insertion of the

proximal locking screws. This will also

allow the limb to be externally rotated

when obtaining a lateral view of the

proximal femur for estimating the screw

size. Confirm visualization of the hip

as well as the shaft of the femur using

image intensification before prepping

and draping.

Reduction

It is important to reduce the

fracture before beginning the

surgical procedure.

Incision and Exposure

Make a medial parapatellar incision

in line with the femoral shaft (Fig 2).

Dissect the soft tissue medial to the

patellar ligament. It is not necessary

to expose the femoral condyles as

placement of the pin is determined

under C-arm control.

Fig. 2

M/DN® Femoral Retrograde Intramedullary Fixation

4

Insert the 9mm Trochanteric Reamer

over the pin, and ream through the

metaphyseal region (Fig. 4). Be sure

to follow the path of the pin, allowing

the reamer to advance through the

metaphyseal bone without binding on

the pin and pushing it up the femoral

canal. Do not ream into the diaphyseal

area. Stop reaming when reduced

resistance is felt. Remove the reamer

and Steinmann Pin.

Creating the Entry Portal

Locating the entry portal is extremely

important to avoid anterior placement

of the nail, involvement of the

intercondylar notch, mediolateral mal-

positioning, or posterior positioning

involving the cruciate ligaments.

Place a smooth Steinmann pin

through the fat pad and onto the

femoral condyles (Fig. 3). Guide the

pin to the notch region using gentle

pressure to avoid any extraneous

scoring of the articular cartilage. Take

A/P and lateral views to check the

proper position. The starting point

should be in line with the femoral canal

on the A/P view, and just anterior to

where Blumensaat’s line intersects

the anterior intercondylar notch on the

lateral view.

Trochanteric

Reamer

Fig. 4

Steinmann

Pin

When the proper position is confirmed,

apply firm pressure on the pin so the

tip engages and maintains its position.

Then adjust the angle of the pin so it is

aligned with the femoral canal. Monitor

the pin alignment with both A/P and

lateral C-arm views as the pin is driven

into the bone.

Advance the pin proximally until

reduced resistance is felt as the pin

exits the metaphyseal region. Make a

final check with A/P and lateral views.

Fig. 3

M/DN® Femoral Retrograde Intramedullary Fixation 5

Fig. 6 Fig. 7

Guide Wire Placement

and Reaming

Conventional Guide Wire/

Exchange Tube Technique

Attach the 3.0mm Ball-Tip Guide

Wire to the Wire-Grip T-Handle and

tighten (Fig. 5). The Ball-Tip Guide Wire

may also be described as a Bulb-Tip

or Bullet-Tip Guide Wire. To aid in

manipulation, bend the wire at a 10˚

angle 5cm from the tip. Insert the

Guide Wire through the entry hole and

manipulate it up the distal femur. At

the fracture site, manipulate the Guide

Wire under C-arm control (Fig. 6). Once

in the proximal canal, pass the wire to

its final position (Fig. 7).

CAUTION: If the guide wire is bent shorter

than 5cm 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 WIRE

GRIP T-HANDLE and mallet to remove the

guide wire from the nail.

The Reduction Finger can be used to

assist in fracture reduction. To use the

Reduction Finger, advance the Guide Wire

and ream the distal segment. Pass the

Reduction Finger over the Ball-Tip Guide

Wire. Manipulate the fracture externally

while using the Reduction Finger internally

to aid in fracture reduction. Once the

Ball-Tip Guide Wire has passed through

the fracture site, the Ball-Tip Guide Wire is

advanced to epiphyseal scar.

If the Ball-Tip Guide Wire can not advance

through the fracture site,

the ball tip of the Guide Wire should

be bent slightly and then reinserted

to aid in internal reduction.

Determine the proper nail length by

placing a second Guide Wire of equal

length at the intercondylar notch. The

length of the wire that is not overlapping

is the correct nail length. The 50cm Ruler

or ossimeter may be used for an accurate

measurement.

Fig. 5

Ball-Tip

Guide Wire

Wire Grip

T-Handle

M/DN® Femoral Retrograde Intramedullary Fixation

6

Alternatively, the Nail Length Gauge can

be used to measure the appropriate

Nail length through measurement of

one 100cm guide wire. To use, place a

100cm Guide Wire down the medullary

canal. Slide the Nail Length Gauge

over the Guide Wire, ensuring that the

distal portion of the gauge is resting on

the distal femur in order to determine

correct nail length. Nail length is

determined by noting the location of

the remaining Guide Wire and reading

the Nail Length Gauge at that particular

location. If the length indicated is

between two available nail sizes, it

is recommended that the shorter nail

be chosen.

NOTE: Nail Length Gauge can only be

used with 100cm Guide Wire.

Remove the Wire-Grip T-Handle, and

place an intramedullary reamer over

the Guide Wire. The Pressure Sentinel®

Intramedullary Reaming System is a

system of one-piece reamers ranging

in size from 5mm diameter to 27mm

diameter in half millimeter increments.

Each reamer is composed of a fluted

reamer head, a shaft and a quick-

connect drive end. The quick-connect

end can be connected to a manual

or powered driver. The width of the

isthmus of the medullary canal is

determined by preoperative x-ray

examination. The instrument with the

smallest possible diameter is used

for initial reaming into the medullary

canal. Reamers with a diameter of 5mm

to 7.5mm use a 2.4mm Ball-Tip Guide

Wire while reamers with a diameter of

8mm to 27mm use a 3.0mm Ball-Tip

Guide Wire. As reaming continues,

the reamer size should be increased

by 0.5mm or 1.0mm increments

until an opening of the desired size

is obtained.

Fig. 8

Exchange Tube

Note: To avoid reamer lodging during

use, reaming should be immediately

stopped and the reamers retracted

when there is too much resistance.

If the reamer becomes lodged, stop

reaming immediately.

Reverse the direction of rotation of the

handpiece and back the reamer out

of the canal. The reamer can also be

extracted by snapping the T-Handle

Extractor onto the reamer end and then

gently tapping the Extractor with a

small mallet or hammer.

CAUTION: Excessive blows to the

T-Handle Extractor may damage the

reamer or the Extractor.

NOTE: The distal end of the nail is

larger than the shaft diameter on some

sizes. Over ream as appropriate to

create clearance for the nail. 9mm-

11mm nails have a 12mm distal end.

New Guide Wire Technique

Option

If using a Ball-Tip Guide Wire that does

NOT have a gold-coated end OR if using

a nail less than 10mm:

NOTE: If the Guide Wire becomes

lodged within the reamer, use the

Wire-Grip T-Handle to push the Guide

Wire back into the IM canal.

When the reaming is complete and

the final measurements are made,

insert the plastic Exchange Tube

over the Ball-Tip Guide Wire. Remove

the Ball-Tip Guide Wire, and insert a

Smooth Guide Wire (Fig 8).

M/DN® Femoral Retrograde Intramedullary Fixation 7

Retrograde Distal

Targeting Guide

Locking

Bolt

Locking

Knob

Fig. 9

If using a Ball-Tip Guide Wire that DOES

have a gold-coated end and if using a

nail equal to or greater than 10mm:

The Ball-Tip Guide Wire can remain in

place. It is NOT NECESSARY to exchange

the Ball-Tip Guide Wire for a Smooth

Guide Wire.

Nail Insertion

Place the selected nail over the Smooth

or Ball-Tip (Gold tipped) Guide Wire and

into the femur. Slide the adjustable arm

of the Retrograde Distal Targeting Guide

approximately to the middle of the

targeting guide base and tighten the

lock knob. Depending on the size of the

patient, it may be necessary to adjust

the position of the arm in or out.

Attach the Retrograde Distal Targeting

Guide to the distal end of the nail

(Fig. 9). Be sure the arrow on the guide

is pointing to the appropriate “Left”

or “Right” indication. Lift and turn the

ratchet lever 90 degrees to open the

ratchet mechanism of the targeting

guide. Insert the Locking Bolt through

the barrel of the guide. Lift and turn the

ratchet lever 90 degrees to close the

ratchet mechanism, and use the Pin

Wrench to tighten the Locking Bolt into

the distal end of the Nail (Fig. 10).

A keyway in the distal end of the nail

will help ensure proper alignment. The

ratchet mechanism will prevent the

Locking Bolt from loosening during

insertion of the nail (Fig. 11).

NOTE: If the ratchet mechanism of

the Retrograde Distal Targeting Guide

does not operate freely, it may be

necessary to disassemble, clean,

and reassemble the mechanism. If

the ratchet mechanism becomes

inoperative, it may be removed. The

assembly will still function; however,

the Locking Bolt may loosen during

the procedure.

Pin Wrench Ratchet

Mechanism

Fig. 10

Fig. 11

M/DN® Femoral Retrograde Intramedullary Fixation

8

Verify proper alignment by inserting

the 5.0mm Femoral Drill Bushing into

the 8.0mm Femoral Screw Bushing.

All retrograde nail sizes use 5.5mm

screws distally (Color Code: Green).

Place the two guide bushings through

one of the inferior holes in the

Retrograde Distal Targeting Guide.

Insert the 5.0mm Femoral drill through

the inner bushing. When the device

is properly aligned, the drill will pass

through the hole of the nail and will

not contact the nail (Fig. 12). After

ensuring proper alignment, remove

the drill and bushings.

Screw the Threaded Driver or

Slaphammer onto the back end of

the Locking Bolt. Begin seating the

Implant/Instrumentation Specifications for Retrograde Nails

Nail Diameter (mm) 910 11 12 13 14

Head Diameter (mm) 12 12 12 12 13 14

Guide Wire, Smooth (mm) 3.0 3.0 3.0 3.0 3.0 3.0

Proximal Screw Size (mm) 4.2

blue

4.2

blue

4.2

blue

5.5

green

5.5

green

5.5

green

Proximal Drill Size (mm) 3.7 3.7 3.7 5.0 5.0 5.0

Proximal Trocar Diameter (mm) 3.7 3.7 3.7 5.0 5.0 5.0

Distal Screw Size (mm) 5.5

green

5.5

green

5.5

green

5.5

green

5.5

green

5.5

green

Distal Drill Size (mm) 5.0 5.0 5.0 5.0 5.0 5.0

Drill Bushing Size (mm) 5.0 5.0 5.0 5.0 5.0 5.0

nail using gentle impaction. While

impacting the nail, use the targeting

guide to maintain the proper rotation.

Take great care when crossing the

fracture site. Visualize the fracture in

two planes with image intensification

to assure proper passage of the nail

into the proximal fragment. Reduce

the force of impaction as the distal

end of the nail approaches the

intercondylar notch.

The Slotted Mallet can be used with

the Threaded Driver to make slight

upward adjustments in depth (Fig. 13).

15mm

Fig. 14

If excessive resistance is encountered

during nail driving, remove the nail

and check the size of both the reamer

and nail. Once proper sizing has been

confirmed, the surgeon may choose to

over ream the canal further or select a

smaller size nail.

Continue to seat the nail. The targeting

guide has a shoulder 15mm from the

end of the nail (Fig. 14). Using this

shoulder as a reference, countersink

the nail approximately 5mm-7mm

below the intercondylar notch. When

the nail is fully seated, remove the

Threaded Driver. Then REMOVE THE

GUIDE WIRE.

Fig. 12

Fig. 13

Note: 4.5mm cortical interlocking screws are NOT indicated for use with the MDN system.

M/DN® Femoral Retrograde Intramedullary Fixation 9

T-Handle

Screwdriver

Long Screw

Depth Gauge

Distal Locking

Slide the arm of the Retrograde Distal

Targeting Guide toward the knee until

it gently contacts the skin, and tighten

the Locking Knob with the Pin Wrench.

Insert the Femoral Screw Bushing

through the Retrograde Distal Targeting

Guide. Make a small incision at the

point where the bushing contacts the

skin. Then insert the 5.0mm Femoral

Drill Bushing (Color Code: Green), into

the Femoral Screw Bushing. Advance

both bushings through the incision

until they contact the bone (Fig. 15).

Fig. 17

Fig. 18

Insert the 5.0mm Femoral Drill (Color

Code: Green) and drill until the medial

cortex is penetrated (Fig. 16). Remove

the drill and Femoral Drill Bushing.

Use the Long Screw Depth Gauge to

determine the screw length (Fig. 17).

Select an appropriate length screw to

ensure adequate engagement of the

outer cortex. Then use the T-Handle

Screwdriver to insert the appropriate

size screw to the correct has mark

(Fig. 18). All retrograde nails use

5.5mm screws distally. Repeat the

procedure for the second and third

distal screws.

NOTE: Distal locking screws for all

femoral nails are 5.5mm in diameter

with lengths ranging from 20mm to

100mm in 2.5mm increments. These

are inserted from lateral to medial.

The proximal anterior to posterior

locking screws for the 9mm through

11mm nails are 4.2mm in diameter

with lengths ranging from 20mm to

90mm in 2.5mm increments. For the

12mm through 14mm diameter nails,

the 5.5mm locking screw can be used

at the proximal anterior to posterior

locking screw positions (Available in

2.5mm length increments.

Fig. 16

Fig. 15

Femoral

Screw

Bushing

Femoral

Drill

Bushing

Drill

Note: 4.5mm cortical interlocking screws are NOT indicated for use with the MDN system.

M/DN® Femoral Retrograde Intramedullary Fixation

10

If the bone is osteoporotic, a Cortical

Nut and Washer are available to

prevent the screw(s) from pulling

out of the bone. After inserting the

Femoral Screw Bushing, insert the

3.7mm radiolucent R-T Bushing (blue).

Then insert a 3.2mm Steinmann Pin

into the R-T Bushing. Use the drill to

drive the pin through both cortices

(Fig 19). Palpate the pin on the medial

side of the knee, and make a small skin

incision to expose the tip of the pin.

Insert the Cortical Nut Counterbore

over the pin and bore into the medial

bone (Fig. 20). Remove the Steinmann

Pin, and the Femoral Pin/Drill Bushing.

Then use the drill to drill through both

cortices (Fig. 21). Remove the Femoral

Fig. 21

Fig. 22

Steinmann Pin

Cortical Nut

Counterbore

Fig. 19

Fig. 20

Drill Bushing and use the Long Screw

Depth Gauge to determine the screw

length (Fig. 22). Select an appropriate

length screw to ensure adequate

engagement of the far cortex.

M/DN® Femoral Retrograde Intramedullary Fixation 11

Cortical

Nut

Cortical Nut

Screwdriver

Washer

Fig. 23

Fig. 24

Use the T-Handle Screwdriver to insert

the appropriate size screw through the

targeting guide. Before the screw enters

the wound, insert a washer onto the

screw (Fig. 23). Then begin driving the

screw into the bone and through the

hole in the nail.

As the screw penetrates the opposite

cortex, observe the screw entering

the cortical nut (Fig 24). Use an image

intensifier to verify proper alignment.

Continue to drive the screw until the

Cortical Nut is tight. Be careful not

to overtighten.

Remove the screwdriver and Femoral

Screw Bushing. Take A/P and lateral

C-arm views to check for correct

positioning. Disengage the ratchet

mechanism, then loosen and remove

the Locking Bolt and the Retrograde

Distal Targeting Guide.

To avoid nonunion and leg length

discrepancy, take A/P and lateral C-arm

views to be sure that the fracture is at

the proper length and not distracted. If

there appears to be distraction, lightly

tap the nail in until the cortices are

properly engaged.

M/DN® Femoral Retrograde Intramedullary Fixation

12

Free-Hand

Targeting

Device

Proximal Locking

Technique for Using the

Free-Hand Targeting Device

The proximal locking screws may be

inserted with a freehand technique

using the Free-Hand Targeting Device.

NOTE: 9mm-11mm retrograde nails

use 4.2mm screws proximally which

require 3.7mm Drills or Trocars (Color

Code: Blue). 12mm-14mm retrograde

nails use 5.5mm screws proximally

which require 5.0mm

Drills or Trocars (Color Code: Green).

Insert an appropriate size Trocar into

the Free-Hand Targeting Device and

finger tighten.

NOTE: 14cm - 22cm length nails in

all diameters have one lateral/medial

proximal dynamic slot and one static

locking hole. 24cm - 48cm length nails

in all diameters have one anterior/

posterior dynamic slot and one static

locking hole.

Choose the appropriate locking hole

based on the need for dynamization.

The inferior locking hole on the M/DN

Retrograde Nail is used for static

locking. If static locking is preferred,

but there is a potential need for later

dynamization, insert screws in both

locking holes. The locking screw in the

static hole can then be removed to

achieve later dynamization.

For success with this technique,

proper placement of the A/P x-ray

beam is critical. Position the C-arm so

the locking hole of the nail appears

perfectly round on the monitor or, if

using the dynamic slot, the slot should

reveal its greatest width (Fig. 25).

When this is achieved, make an

anterior stab wound opposite the

appropriate locking hole. Bring the tip

of the Trocar to the bone and center it

over the locking hole using the C-arm

(Fig. 26).

Fig. 26

Incorrect

Correct

Fig. 27

Drive the Trocar into the bone and

across the hole in the nail in line

with the A/P x-ray beam, but do not

penetrate the posterior cortex (Fig. 27).

Remove the Free-Hand Targeting

Device. Verify Trocar placement in both

the A/P and lateral planes. Proximal

Bushings can be used with the Free-

Hand Targeting Device. A separate

radiolucent Bushing Insert is available

to accommodate the bushings. Insert

the 3.7mm or 5.0mm Proximal Bushing

and the 8.0mm Proximal Bushing into

the targeting device, and place it over

the Trocar (see chart on page 6 for

correct size information). Advance the

bushings to the bone and check their

position with the C-arm.

Fig. 25

Note: 4.5mm cortical interlocking screws are NOT indicated for use with the MDN system.

M/DN® Femoral Retrograde Intramedullary Fixation 13

After it has been correctly placed,

remove the Trocar and the 5.0mm

Proximal Bushing. The path of the

Trocar in the bone acts as a pilot hole

for the appropriate size drill. Insert

the Proximal Stop Drill into the 8.0mm

Proximal Bushing. Before drilling

through the anterior cortex, check the

A/P and lateral C-arm image to assure

that the drill is in the hole in the nail.

Then drill both cortices. The step in the

drill will prevent over-drilling (Fig. 28).

Fig. 29

Fig. 28

Fig. 30

Short

Screw

Depth

Gauge

Proximal

Drill

w/Stop

If desired, insert the second screw in

the second locking hole of the nail in

an identical manner (Fig. 31). Check the

position of both screws with the C-arm

in the A/P and lateral planes (Fig. 32).

Fig. 31

Fig. 32

Remove the drill and insert the Short

Screw Depth Gauge (Fig. 29). The

length of the screw is determined by

reading it directly off the depth gauge.

Select an appropriate length screw to

ensure adequate engagement of the

far cortex. Insert the appropriate size

M/DN Screw using the appropriate

screwdriver (Fig. 30).

M/DN® Femoral Retrograde Intramedullary Fixation

14

End Cap Placement

If desired, insert the Retrograde

Femoral Locking Nail Cap in the distal

end of the nail to ensure secure fixation

with the distal oblique screw.

Closure and Postoperative Care

Thoroughly irrigate the knee and

close the distal wound. Apply a soft

compression dressing.

Extraction

Should extraction of the nail become

necessary, attach the Threaded

Extractor to the end of the nail and use

a Slaphammer to extract the nail. If

an End Cap had been used, be sure to

remove before attempting to remove

the nail.

NOTE: The cannulated Locking

Bolt should not be used for nail

removal. Extraction of the nail

should be accomplished by using

the Threaded Extractor.

M/DN® Femoral Retrograde Intramedullary Fixation 15

Instrument Case Options

M/DN Instruments

Option A (Metal Femoral/MIS Femoral/Retrograde)

Set Number 00-2255-000-17 (includes case/tray/lid + instruments)

Case Set Number 00-2237-090-00 (includes trays and lid)

Metal Femoral Guides/Instruments (top tray holds the

following)

Prod. No. Description

00-2255-001-03 Locking Bolt Assembly 2

00-2255-002-10 Fem. Prox. Targeting Guide 1

00-2255-002-11 Fem. Prox. Targeting Guide 1

00-2255-004-32 3.2mm Pin Bushing 2

00-2255-004-50 5.0mm Drill Bushing 2

00-2255-004-80 8.0mm Screw Bushing 2

00-2255-011-00 Recon Screw Counterbore 1

00-2258-067-00 ITST ® Threaded Guide Pin 355mm 3

00-2255-028-00 Pin Wrench 1

00-2255-035-50 5.0mm Femoral Drill, Large 3

MIS Guides (middle tray holds the following; must be used

with above tray)

Prod. No. Description

00-2255-003-03 Perc. Recon Arm Set Screw 2

00-2255-028-00 Pin Wrench 1

00-2255-050-01 Fem. Perc. Targeting Guide 1

00-2255-050-02 Fem. Perc. Targeting Guide 1

00-2255-051-00 Perc. Recon Arm 1

00-2255-053-00 Perc. Cannula 1

00-2255-054-00 Perc. Centering Bushing 1

00-2255-058-00 Per. Locking Bolt 2

Retrograde Femoral Instruments (base of case holds the

following)

Prod. No. Description

00-2241-001-00 Retro. Targ. Guide Assembly (4 pcs.) 1

00-2241-001-01 Adj. Targ. Arm Assembly (5 pcs.) 1

00-2241-006-00 Cortical Nut Screwdriver 1

00-2241-008-37 3.7mm Drill Bushing 2

00-2241-008-50 5.0mm Drill Bushing 2

00-2258-067-00 ITST Threaded Guide Pin 355mm 3

00-2255-001-00 Locking Bolt 2

00-2255-004-80 8.0mm Screw Bushing 2

00-2255-028-00 Pin Wrench 1

00-2255-031-37 3.7mm Drill 1

00-2255-035-50 5.0mm Drill, Large 1

00-2255-059-00 Nail Cap Inserter

(captured screwdriver)

1

M/DN® Femoral Retrograde Intramedullary Fixation

16

M/DN Instruments

Option B (Metal Femoral/Tibial/Humeral/Retrograde)

Set Number 00-2255-000-18 (includes case/tray/lid + instruments)

Case Set Number 00-2237-068-00 (includes trays and lid)

Metal Femoral Guides/Instruments (top tray holds the

following)

Prod. No. Description

00-2255-001-03 Locking Bolt Assembly 2

00-2255-002-10 Fem. Prox. Targeting Guide 1

00-2255-002-11 Fem. Prox. Targeting Guide 1

00-2255-004-32 3.2mm Pin Bushing 2

00-2255-004-50 5.0mm Drill Bushing 2

00-2255-004-80 8.0mm Screw Bushing 2

00-2255-011-00 Recon Screw Counterbore 1

00-2258-067-00 ITST Threaded Guide Pin 355mm 3

00-2255-028-00 Pin Wrench 1

00-2255-035-50 5.0mm Femoral Drill, Large 3

Tibial/Humeral Instruments (middle tray holds the following)

Prod. No. Description

00-2255-001-00 Locking Bolt 2

00-2255-003-00 Tibial Proximal Targeting Guide 1

00-2255-003-01 Tibial Oblique Hole Adapter 1

00-2255-003-03 Set Screw 2

00-2255-004-00 Humeral Proximal Targeting Guide 1

00-2255-004-01 Humeral Oblique Hole Adapter 1

00-2255-036-37 Tib./Hum. 3.7mm Drill Bushing 2

00-2255-036-80 Tib./Hum. 8.0mm Screw Bushing 2

00-2255-028-00 Pin Wrench 1

00-2255-032-37 Tib./Hum. 3.7mm Drill 2

Retrograde Femoral Instruments (base of case holds the

following)

Prod. No. Description

00-2241-001-00 Retro. Targ. Guide Assembly (4 pcs.) 1

00-2241-001-01 Adj. Targ. Arm Assembly (5 pcs.) 1

00-2241-006-00 Cortical Nut Screwdriver 1

00-2241-008-37 3.7mm Drill Bushing 2

00-2241-008-50 5.0mm Drill Bushing 2

00-2258-067-00 ITST Threaded Guide Pin 355mm 3

00-2255-001-00 Locking Bolt 2

00-2255-004-80 8.0mm Screw Bushing 2

00-2255-028-00 Pin Wrench 1

00-2255-031-37 3.7mm Drill 1

00-2255-035-50 5.0mm Drill, Large 1

00-2255-059-00 Nail Cap Inserter

(captured screwdriver)

1

M/DN® Femoral Retrograde Intramedullary Fixation 17

General Instrument Set

Set Number 00-2255-000-16 (includes case/tray/lid + instruments)

Case Set Number 00-2237-095-00 (includes trays and lid)

General Instruments (top tray holds the following)

Prod. No. Description

00-2237-053-00 Wire Grip T-Handle 1

00-2237-061-00 Long T-Handle Cannulated Awl 1

00-2237-066-00 Short T-Handle Cannulated Awl 1

00-2255-016-00 7mm Angled Femoral Awl* 1

00-2255-034-00 Reduction Finger 1

00-2255-052-00 9mm/14mm Perc. Tapered Reamer 1

00-2255-060-00 8mm Trochanteric Reamer 1

00-2258-067-00 ITST Threaded Guide Pin 355mm 3

00-2255-038-00 T-Handle 1

00-4816-060-00 Ball-Spiked Pusher 1

00-4817-011-00 Shoulder Hook 1

General Instruments (middle tray holds the following)

Prod. No. Description

00-2228-097-00 Diameter Gauge 1

00-2237-055-00 Ruler 1

00-2255-057-00 Flexible Reamer Extension 2

00-2305-024-00 Screwdriver, Small Hexhead 1

00-2237-060-00 Slotted Mallet 1

00-2237-062-00 Threaded Driver 1

00-2237-063-00 Screw Depth Gauge, Long 1

00-2255-013-00 Screwdriver 3.5mm Hex, Long 1

00-2255-017-00 Flared Exchange Tube 1

00-2237-064-00 Nail Length Gauge 1

00-2258-057-00 Cannulated Depth Gauge 1

General Instruments (base of case holds the following)

Prod. No. Description

00-2255-009-00 Slaphammer 1

00-2255-028-00 Pin Wrench 1

00-2237-065-00 Threaded Extractor (17cm) 1

00-2237-065-01 Threaded Extractor (32cm) 1

00-2255-012-33 3.2mm Trocar 3

00-2255-012-37 3.7mm Trocar 3

00-2255-012-50 5.0mm Trocar 3

00-2255-033-32 3.2mm Drill 3

00-2255-033-37 3.7mm Drill 3

00-2255-033-50 5.0mm Drill 3

00-2255-018-00 Distal Screw Depth Gauge 1

00-2255-013-01 Distal Screwdriver 3.5mm Hex 1

00-2255-015-03 Wand Handle 1

00-2255-015-01 Wand Insert 1

00-2255-015-02 Wand Set Screw 1

* The 7mm Straight Awl (00-2237-001-07) OR the

7mm Angled Femoral Awl (00-2255-016-00) will

fit in the case. However, when you order the set

number (00-2255-000-16), you will get the Angled Awl.

NOTE: See sales representative for optional instruments.

M/DN® Femoral Retrograde Intramedullary Fixation

18

Pressure Sentinel Intramedullary Reaming System

Order Information

Prod. No. Description

00-2218-000-00 Long Pressure Sentinel Reamers

Tray/Case/Lid

Includes the following instruments & case:

00-2218-008-00 8.0mm Long Flexible PS Reamer

00-2218-008-05 8.5mm Long Flexible PS Reamer

00-2218-009-00 9.0mm Long Flexible PS Reamer

00-2218-009-05 9.5mm Long Flexible PS Reamer

00-2218-010-00 10.0mm Long Flexible PS Reamer

00-2218-010-05 10.5mm Long Flexible PS Reamer

00-2218-011-00 11.0mm Long Flexible PS Reamer

00-2218-011-05 11.5mm Long Flexible PS Reamer

00-2218-012-00 12.0mm Long Flexible PS Reamer

00-2218-012-05 12.5mm Long Flexible PS Reamer

00-2218-013-00 13.0mm Long Flexible PS Reamer

00-2218-013-05 13.5mm Long Flexible PS Reamer

00-2218-014-00 14.0mm Long Flexible PS Reamer

00-2218-014-05 14.5mm Long Flexible PS Reamer

00-2218-015-00 15.0mm Long Flexible PS Reamer

00-2218-015-05 15.5mm Long Flexible PS Reamer

00-2218-016-00 16.0mm Long Flexible PS Reamer

00-2218-016-05 16.5mm Long Flexible PS Reamer

00-2218-017-00 17.0mm Long Flexible PS Reamer

00-2218-017-05 17.5mm Long Flexible PS Reamer

00-2218-018-00 18.0mm Long Flexible PS Reamer

00-2228-030-00 T-Handle Extractor

00-2228-097-00 Diameter Gauge

00-5044-012-00 Adapter 3 Jaw Chuck

00-2228-098-10 Soak Tray

00-2218-025-00 Long Cleaning Brush

00-2218-030-00 Torque Limiter

00-2237-075-00 Long Reamer/Instrument

Case Assembly

00-2237-076-00 Long Reamer/Instrument Case Base

00-2237-077-00 Long Reamer/Instrument Case Lid

00-2237-078-00 Long Reamer/Instrument Top Tray

(8mm-13.5mm)

00-2237-079-00 Long Reamer/Instrument Middle Tray

00-2228-000-00 Pressure Sentinel Reamer Full Set

Includes the following instruments & case:

00-2228-005-00 5.0mm Flexible Reamer

00-2228-005-05 5.5mm Flexible Reamer

00-2228-006-00 6.0mm Flexible Reamer

00-2228-006-05 6.5mm Flexible Reamer

00-2228-007-00 7.0mm Flexible Reamer

00-2228-007-05 7.5mm Flexible Reamer

00-2228-008-00 8.0mm Flexible Reamer

00-2228-008-05 8.5mm Flexible Reamer

00-2228-009-00 9.0mm Flexible Reamer

00-2228-009-05 9.5mm Flexible Reamer

00-2228-010-00 10.0mm Flexible Reamer

00-2228-010-05 10.5mm Flexible Reamer

00-2228-011-00 11.0mm Flexible Reamer

00-2228-011-05 11.5mm Flexible Reamer

00-2228-012-00 12.0mm Flexible Reamer

00-2228-012-05 12.5mm Flexible Reamer

00-2228-013-00 13.0mm Flexible Reamer

00-2228-013-05 13.5mm Flexible Reamer

00-2228-014-00 14.0mm Flexible Reamer

00-2228-014-05 14.5mm Flexible Reamer

00-2228-015-00 15.0mm Flexible Reamer

00-2228-015-05 15.5mm Flexible Reamer

00-2228-016-00 16.0mm Flexible Reamer

00-2228-016-05 16.5mm Flexible Reamer

00-2228-017-00 17.0mm Flexible Reamer

00-2228-017-05 17.5mm Flexible Reamer

00-2228-018-00 18.0mm Flexible Reamer

00-2228-018-05 18.5mm Flexible Reamer

00-2228-019-00 19.0mm Flexible Reamer

00-2228-019-05 19.5mm Flexible Reamer

00-2228-020-00 20.0mm Flexible Reamer

00-2228-020-05 20.5mm Flexible Reamer

00-2228-021-00 21.0mm Flexible Reamer

00-2228-021-05 21.5mm Flexible Reamer

00-2228-022-00 22.0mm Flexible Reamer

00-2228-030-00 T-Handle Extractor

00-2228-097-00 Diameter Gauge

00-2228-098-00 Soak Tray

00-5044-012-00 1/4in. Jacob’s Chuck to Zimmer

Adapter, Qty =2

00-2228-090-00 Sterilization Case

M/DN® Femoral Retrograde Intramedullary Fixation 19

Optional Reamer Sizes

Prod. No. Description

00-2228-022-05 22.5mm Flexible Reamer

00-2228-023-00 23.0mm Flexible Reamer

00-2228-023-05 23.5mm Flexible Reamer

00-2228-024-01 24.0mm Flexible Reamer

00-2228-024-05 24.5mm Flexible Reamer

00-2228-025-01 25.0mm Flexible Reamer

00-2228-025-05 25.5mm Flexible Reamer

00-2228-026-01 26.0mm Flexible Reamer

00-2228-026-05 26.5mm Flexible Reamer

00-2228-027-01 27.0mm Flexible Reamer

Pressure Sentinel Sets

Prod. No. Description

00-2228-000-01 Pressure Sentinel Reamer Trauma Set

Includes the following instruments & case:

5.0mm, 6.0mm, 7.0mm & 8.00mm-17.5mm

Flexible Reamers in .5mm increments (1ea.)

00-2228 -030-00 T-Handle Extractor

00-5044-012-00 1/4in. Jacob’s Chuck to Zimmer

Adapter, Qty=2

00-2228-090-00 Sterilization Case

00-2228-000-02 Pressure Sentinel Reamer Hip Set

Includes the following instruments & case:

8.0mm-18.0mm Flexible reamers in 1mm increments (1ea.)

00-2228-030-00 T-Handle Extractor

00-5044-012-00 1/4in. Jacob’s Chuck to Zimmer

Adapter, Qty=1

00-2228-090-00 Sterilization Case

00-2228-000-03 Pressure Sentinel Reamer Expanded

Hip Set

Includes the following instruments & case:

8.0mm-18.0mm Flexible reamers in .5mm increments (1ea.)

00-2228-030-00 T-Handle Extractor

00-5044-012-00 1/4in. Jacob’s Chuck to Zimmer

Adapter, Qty=1

00-2228-090-00 Sterilization case

00-2228-90-00 Sterilization Case

Includes the following components:

00-2228-091-00 Base

00-2228-092-00 18.0mm to 22.0mm Reamer Tray

00-2228-093-00 12.0mm to 17.5mm Reamer Tray

00-2228-094-00 5.0mm to 11.5mm Reamer Tray

00-2228-096-00 Case Lid

00-9975-011-00 Pressure Sentinel Reamer ZMR® Hip Set

Includes the following components:

8.0mm-27.0mm Flexible reamers in .5mm increments (1ea.)

00-9965-081-10 ZMR Flexible Reamer

Diameter Gauge

00-9975-099-00 Case Lid

00-2228-040-00 ZMR Flexible Reamer Metal Case

* Set includes case and contents without the

00-9975-099-00 Case Lid. The Case Lid must

be ordered separately.

Optional Instruments

Prod. No. Description

00-2255-008-00 Guide Wire 2.4mm, Ball-Tip,

70cm box (required for 5.0mm-7.5mm

Pressure Sentinel Reamers)

47-2255-008-01 Guide Wire 3.0mm, Ball-Tip, 100cm

Sterile/box (required for 8.0mm and larger

Pressure Sentinel Reamers)

00-2255-008-01 Guide Wire 3.0mm, Ball-Tip, 100cm

Non-sterile/box (required for 8.0mm and

larger Pressure Sentinel Reamers)

Contact your Zimmer representative or visit us at www.zimmer.com

97-2252-009-01 Rev. 3 MC 120710 6-1-2015 ©2015 Zimmer, Inc.

The CE mark is valid only if it is also printed on the product label.

DISCLAIMER:

This documentation is intended exclusively for physicians and is not intended for laypersons. Information on

the products and procedures contained in this document is of a general nature and does not represent and does

not constitute medical advice or recommendations. Because this information does not purport to constitute any

diagnostic or therapeutic statement with regard to any individual medical case, each patient must be examined

and advised individually, and this document does not replace the need for such examination and/or advise in

whole or in part.

Please refer to the package inserts for important product information, including, but not limited to, indications,

contraindications, warnings, precautions, and adverse effects.