Zimmer Natural Nail System Cephalomedullary Surgical Technique Standard 97 2493 002 00 Rev. 6

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Zimmer®

Natural Nail®

System

Cephalomedullary Nail

Surgical Technique

STANDARD

Zimmer® Natural Nail® System Cephalomedullary Nail Surgical Technique - Standard 1

Zimmer Natural Nail

System Cephalomedullary

Nail Surgical Technique -

Standard

Table of Contents

Product Overview 2

Implant Overview 2

Indications 2

Contraindications 2

Surgical Technique 2

Preoperative Planning 2

Patient Positioning 2

Reduction 3

Starting Point Location 3

Proximal Reaming 4

Shaft Reaming 5

Implant Selection 5

Nail Assembly and Insertion 5

Lag Screw Placement 7

Distal Targeting For Short Nails 10

Freehand Technique for Long Nails 11

Final Implant Placement 11

Postoperative Care 11

Nail Extraction 11

Cephalomedullary Long Nail Details 13

Cephalomedullary Short Nail Details 14

Product Information 15

Zimmer® Natural Nail® System Cephalomedullary Nail Surgical Technique - Standard

Product Overview

The Zimmer Natural Nail System is a

system of intramedullary nails, screws,

instruments and other associated

implants that are designed to provide

stable internal fixation for fractured long

bones. The nails have been designed

for specific applications to help restore

the shape of the fractured bone to its

natural, pre-injured state.

The Cephalomedullary Nail was

designed to help treat fractures of the

femur, especially intertrochanteric

and subtrochanteric fractures. The nail

features a small proximal section that

is designed to minimize the amount

of bone that must be removed for nail

insertion. A lag screw is placed through

the nail into the femoral head to secure

the nail in place proximally and help

control the different segments of the

bone while healing occurs. Screws are

placed through the nail distally to further

secure the implant in place and maintain

length and alignment while healing

occurs.

A choice of short and long nails, as

well as nails of different diameters and

center-column-diaphyseal (CCD) angles

are available to best match the individual

anatomy of the patient.

Implant Overview

Nail Diameters: 10, 11.5, 13, 14.5 (14.5

is available only for short nails)

Nail Lengths: 21.5cm (short), 30 to 48cm

in 2cm increments

CCD Angles: 125°, 130°, 135°

Lag Screw Diameter: 10.5mm

Lag Screw Lengths: 70 to 130mm in

5mm increments

Distal Screw Diameter: 5.0mm

Distal Screw Lengths: 20 to 60mm in

2.5mm increments, 65 to 100mm in

5mm increments

Distal Screws available in fully- and

partially-threaded configurations

Materials: Ti-6Al-4V alloy

Precision instrumentation is provided

to help implant the nail. Many of the

instruments and implants feature a color

coding system to help the surgical team

use the system. Certain instruments are

not color coded. The color coding system

is referenced in the technique. A wall

chart (97-2493-003-00) is also available

to help explain the color coding system.

Indications

The Zimmer Natural Nail System is

intended for temoraty fracture fixation

and stabilization of the bone.

Indications for the Cephalomedullary

nails include:

• Compoundandsimpleshaftfractures

• Proximal,metaphysealanddistalshaft

fractures

• Segmentalfractures

• Comminutedfractures

• Fracturesinvolvingosteopenicand

osteoporotic bone

• Pathologicalfractures

• Fractureswithboneloss

• Pseudoarthrosis,non-union,mal-

union and delayed 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 functioning and the

success of the implant

• Infection

• Insufficientbloodcirculation

• Skeletallyimmaturepatients

WARNING: This nail should only be used

to treat a periprosthetic fracture if the in

situ device is firmly fixed. When treating

a periprosthetic fracture, the nail should

be positioned so that it does not come in

contact with the in situ device.

Surgical Technique

Preoperative Planning

Preoperative planning is recommended

before beginning the surgical procedure.

An A/P and Lateral x-ray 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.

Zimmer® Natural Nail® System Cephalomedullary Nail Surgical Technique - Standard 3

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, ball

spikepushersandSteinmannpins.

Starting Point Location

Palpate the greater trochanter manually.

Incisetheskinstartingabout2cm

proximal to the tip of the greater

trochanter and extending proximally 2

to 3 cm. Dissect through the tissues

splitting the fascia lata down to the

bone. Assemble the STARTING POINT

LOCATOR inside the ENTRY CANNULA.

Place the tip of the STARTING POINT

LOCATOR through the incision down to

thetipofthegreatertrochanter(Fig.1).

In large patients and/or when using the

standard guide, a more proximal incision

may be appropriate.

Place the 3.0mm PIN through the center

hole of the STARTING POINT LOCATOR.

Use the C-arm to 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 tip

of the greater trochanter may lead to a

varus reduction following nail insertion.

If necessary, remove the pin and move

it into the hole in the STARTING POINT

LOCATOR that will align the pin correctly

with the tip of the greater trochanter.

Drive the pin through the tip of the

greater trochanter down to the level

of the lesser trochanter. Remove the

STARTING POINT LOCATOR from the

ENTRY CANNULA. Use the 8mm ENTRY

REAMER to ream an entry portal into the

proximal femur through the starting point

on the tip of the greater trochanter

(Fig2).Removethereamerand

3.0mm pin.

Fig. 1

Alternatively, a CANNULATED AWL can be

used to find the entry point and create

theentryportal(Fig.3).Wideningof

the fracture side and varus tilting of the

proximal fragment should be avoided.

Fig. 2

Fig. 3

Zimmer® Natural Nail® System Cephalomedullary Nail Surgical Technique - Standard

AREDUCTIONFINGERisincludedintheset.

The ball tip 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 a LONG NAIL is to be implanted, assemble

the Two Piece NAIL LENGTH GAUGE. This step

canbeskippedifusingashortnail(21.5cm

in length). Slide the tube portion of the gauge

over the 3.0mm x 100cm GUIDE WIRE until

the tip of the tube is at the level of the tip

of the greater trochanter (confirm position

usingfluoroscopy)(Fig.6).Theproximalend

of the GUIDE WIRE indicates the length of

the wire in the canal. When determining nail

length,considerationshouldbetakenasto

how deep the nail will be inserted into the

femur based upon the shape of the patient’s

proximal femur. A RULER is also included in

the set which can be used to radiographically

determine nail length.

Proximal Reaming

Usethe15.5mmTAPEREDREAMER(BLUE)to

prepare the proximal femur for the proximal

portionofthenail(Fig.7).TheC-armshould

be used to visualize the depth of the reamer

intheproximalfemur.Careshouldbetaken

tokeepthereamerinlinewiththeshaftofthe

femur to avoid reaming through the cortex of

the femur.

The 15.5mm TAPERED REAMER has three

grooves on it. The most proximal groove

indicates the final position of the top of the

nail. The two distal grooves help visualize the

placement of the lag screw. Visualizing a line

between these grooves on each side of the

reamer (under fluoroscopic visualization) will

indicate where a 130° CCD angle lag screw

wouldbeplacedinthefemoralneckandhead.

Placea3.0mmx100cmBALLTIPGUIDEWIRE

or TEAR DROP GUIDE WIRE through the ENTRY

CANNULA,allthewayintothedistalfemur(Fig.

4). To aid in manipulation, bend the tip of the

GUIDE WIRE at about a 10o angle 5cm from the

end.

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 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 scar

using the GUIDE WIRE GRIPPER and a MALLET

(Fig.5).Careshouldbetakennottodrivethe

wirethroughthekneejoint.

A CHANNEL REAMER is also available for

proximal reaming. The INNER CHANNEL

REAMER is placed inside the 14.5mm

CHANNEL REAMER SLEEVE and secured

by twisting the connector. The CHANNEL

REAMER is then advanced over the GUIDE

WIRE through the greater trochanter. Advance

the reamer to level of the lesser trochanter

(Fig.8),ordeepenoughtoaccommodatethe

proximal body of the nail.

Fig. 4

Fig. 5 Fig. 6

Fig. 7

Fig. 8

Zimmer® Natural Nail® System Cephalomedullary Nail Surgical Technique - Standard 5

Fig. 15

After reaming to the proper depth, the INNER

CHANNEL REAMER is removed by disengaging

the connector and pulling the INNER

CHANNEL REAMER out of the surgical field

(Fig.9).TheCHANNELREAMERSLEEVEcan

be left in place to act as a tissue protection

sleeve during shaft reaming for shaft reamers

up to 13mm in diameter. To achieve greater

reaming depth or diameter, the ENTRY

CANNULA can be used in place of the sleeve.

To facilitate reamer removal via the sleeve,

power the reamer until it enters the sleeve.

FollowingshaftreamingtheCHANNEL

REAMER SLEEVE should be removed from the

surgicalfield(Fig.10).

Shaft Reaming

Reaming should be performed through

theENTRYCANNULA.Toreducetherisk

of enlarging the entry hole laterally, push

the ENTRY CANNULA medially. Start with a

small reamer. Increase the diameter of the

reamer by 0.5 - 1.0mm depending on the

amount of resistance felt while reaming.

(Fig.11).Whencorticalchatteroccurs,stop

reaming. Choose a nail that is 1.5 - 2.0mm

smaller than the last reamer used. If a short

nail is to be used, it is only necessary to

ream the proximal 21.5cm of the canal. If a

long nail is planned, ream the full length of

the canal. The GUIDE WIRE PUSHER can help

prevent the 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 IM canal.

Implant Selection

The diameter and length of the nail have

already been determined (using nail length

gauge and last size of reamer utilized).

Visualizing the reduced femur and/or the

contralateral femur, determine which CCD

angle is appropriate for the patient.

Nail Assembly and Insertion

The color code for the cephalomedullary

nailisBLUE.Ti-6Al-4Valloynails,the

TARGETING GUIDE and the CONNECTING

BOLTallhavebluecolorsonthem,aswell

asthewordBLUEonthem.

Fig. 11

Fig. 14

Both a MODULAR STANDARD

(00-2490-003-10) and STANDARD

(00-2490-003-00) TARGETING GUIDE

exists. When implanting a short

nail the STANDARD TARGETING

GUIDE (Fig. 12) must be used. When

implanting a long nail, either the

MODULAR STANDARD TARGETING

GUIDE (Fig. 13) or STANDARD

TARGETING GUIDE can be used.

PlacetheCONNECTINGBOLTthroughthe

barreloftheTARGETINGGUIDE(Fig.14).

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.

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 tines on the barrel of

the TARGETING GUIDE. Completely tighten

theCONNECTINGBOLTusingan11mm

WRENCH to secure the nail to the guide

(Fig15).

Fig. 12

Fig. 13

Fig. 9

Fig. 10

Zimmer® Natural Nail® System Cephalomedullary Nail Surgical Technique - Standard

Lay the guide attached to the nail over

the femur. Confirm that the bow of the

nail is anterior similar to the bow of the

femur. Confirm also that the lag screw

hole in the nail is oriented to guide a

lag screw into the femoral head. Care

mustbetakentoensurethatthecorrect

nail is selected and that it is assembled

correctly to the guide. If this is not

the case, loosen and reattach the nail

appropriately or choose the correct nail

and attach it to the guide.

Use a LAG SCREW CANNULA and the

LAG SCREW REAMER or a CANNULA,

DRILL SLEEVE AND DRILL to verify

that the guide will target all required

holes in the nail correctly. Hole

indicators can be placed in static

(ST) and dynamic (DY) holes of the

targeting guide and in holes for CCD

angles that will not be used to avoid

the accidental use of those holes

during the surgery. Use a push-

and-twist motion when inserting the

hole indicators to help ensure that

they stay in place.

The STANDARD TARGETING GUIDE

is designed to target the transverse

distal static (ST) and dynamic (DY)

holes in SHORT 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 versa). The holes that

will be used to place screws into the

distal portion of SHORT NAILS are on

the anterior side of the guide when

the patient is in a supine position.

The MODULAR STANDARD

TARGETING GUIDE (00-2490-003-

10) is not designed to target the

transverse distal static (ST) and

dynamic (DY) holes and therefore

should not be used with short nails.

Insert the nail over the GUIDE WIRE with

the arm of the guide facing anteriorly

(Fig.16).

As the nail passes through the canal,

it will naturally turn approximately 90°

until the anterior bow of the nail is in line

with the bow of the femur. Monitor the

progression of the nail down the canal

using the C-arm, especially as the nail is

passing through or near the fracture site.

CAUTION: Do not pry excessively on the

targeting guide as damage may result.

If the nail does not pass down the canal

easily, attach the IMPACTION HEAD to the

TARGETING GUIDE. Using the MALLET,

impact gently on the IMPACTION HEAD

(Fig.17).

CAUTION: Do not strike excessively as

damage to the guide and bone may

result. Verify that the CONNECTING BOLT

is tight while, and after, impacting.

Do not impact on any portion of the

TARGETING GUIDE as this may break the

guide or cause it to lose its accuracy.

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 verified by placing a

threadedguidepinthroughtheskinand

soft tissue along the anterior axis of the

femoralneck.

Remove the GUIDE WIRE from the nail

using the GUIDE WIRE GRIPPER.

If it is desired to utilize an antirotation

pin to assist in stabilizing the femoral

head during lag screw preparation and

insertion, a 3.2mm PIN can be used.

It can be placed using a freehand

technique anterior to the nail and into

thefemoralneckandhead.1,2

Fig. 16

Fig. 17

Zimmer® Natural Nail® System Cephalomedullary Nail Surgical Technique - Standard 7

Lag Screw Placement

FortheSTANDARDandMODULAR

STANDARDGUIDES,instrumentsmarked

BLUEareutilizedtoplacetheLAGSCREW.

Marksonthetargetingguidesnearthe

holes indicate the color of cannula that

should be passed through that specific

hole. The chart below details the color

coded instruments that are used to target

and place the lag screw.

Instrument Type Standard

Lag Screw Cannula Blue

Lag Screw Pin Sleeve Blue

Lag Screw Reamer Blue

Lag Screw Tap Blue

Lag Screw Inserter Blue

Lag Screw Retaining Shaft Blue

CAUTION: Retighten the CONNECTING

BOLT to the nail to maintain targeting

accuracy.

The Tip-Apex Distance (TAD), the sum of

the distances 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 25mm.3

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overtheskininlinewith

the LAG SCREW CANNULA to help estimate

this position and correct CCD angle.

NOTE: If planning to use an ANTIROTATION

PIN to further stabilize the femoral head,

insert the DOUBLE CANNULA instead of

the LAG SCREW CANNULA.

Assemble the LAG SCREW TROCAR into

the LAG SCREW CANNULA and pass

through the correct hole in the TARGETING

GUIDE for the chosen CCD angle. The lag

screw hole labeled 125 is designed to

be used with the long and short nails

containing a 125º CCD angle, the lag

screw hole labeled 130 is designed to

be used with the long and short nails

containing a 130º CCD angle, and the

lag screw hole labeled 135 is designed

to be used with the long and short nails

containinga135ºCCDangle.Makea

smallskinincision,thendissectthrough

the fascia and other soft tissues down to

the bone. Advance the cannula through

theguidedowntothebone(Fig.18).

CAUTION: Do not impact on the cannula,

as the tip of the cannula may skive along

the bone and prevent accurate targeting

Fig. 18

CAUTION: Both 3.0mm and 3.2mm

instruments (guide pins, depth gauges,

reamers, taps, pin sleeves) are available.

The 3.2mm versions of the instruments

can easily be distinguished as they

have gold coating on them. The 3.0mm

and 3.2mm instruments can not be

used interchangeably. Mixing of these

instruments can lead to lag screw mis-

measurement which could result in patient

injury and/or damage to the instruments.

This technique describes use of the 3.2mm

instruments. The 3.0mm instruments can

be used in an identical fashion.

Fig. 19

AnotherA/PC-armimagecanbetakenat

this point to ensure that the TARGETING

GUIDE is still aligned correctly by

visualizing a line extending from the

center of the cannula into the femoral

head. Remove the TROCAR and insert

the 3.2mm LAG SCREW PIN SLEEVE.

Insert a 3.2mm PIN through the PIN

SLEEVE. Under fluoroscopy, drill the PIN

to the level of the subchondral bone of

the femoral head without penetrating the

femoralcortex(Fig.19).

Assess the position of the PIN using the

C-arm in the A/P and Lateral planes. If

the PIN is appropriately placed, proceed

with the next steps.

NOTE: If the PIN is not appropriately

placed, remove it, adjust the guide

under fluoroscopy and replace the PIN

correctly.

TECHNIQUE TIP – If the PIN appears to be

changing direction at the point it enters

the lateral cortex of the femur, remove

the pin and pin sleeve and perforate

the lateral cortex using the lag screw

reamer. Replace the pin sleeve in the

cannula and drive the pin as previously

stated to the level of the subchondral

bone in the femoral head.

The holes proximal to the lag

screw cannula holes in the

STANDARD TARGETING GUIDE are

used merely as a general reference

for the pin placement through the

implant antirotation pin hole and

must not be solely relied upon to

accurately place the pin.

3Baumgaertneret.al.,Thevalueofthetip-apexdistanceinpredictingfailureoffixationofperitrochantericfracturesofthehip,JBoneJointSurgAM.1995:77:1058-1064

Zimmer® Natural Nail® System Cephalomedullary Nail Surgical Technique - Standard

Fig. 21

Fig. 22

Remove the 3.2mm LAG SCREW PIN

SLEEVE from The LAG SCREW CANNULA.

Slide the CANNULATED LAG SCREW

DEPTH GAUGE over the 3.2mm PIN down

tothebone(Fig.21).

Confirm that the depth gauge is touching

the lateral cortex of the femur using

fluoroscopy to accurately determine the

length of lag screw to be used. The end of

Fig. 23

Fig. 24

Fig. 25

If it is desired to utilize an ANTIROTATION

PIN to assist in stabilizing the femoral

head during lag screw insertion, a

3.0mm ANTIROTATION PIN can be placed

intothefemoralneckandheadusing

aDOUBLECANNULA.Usethesmaller

sleeveoftheDOUBLECANNULAtoplace

this pin at this time. The pin is passed

so that it does not penetrate the femoral

cortexinthefemoralheadorneck(Fig.

20). Place pin to appropriate depth beyond

fracture site to provide stabilization.

NOTE: Place the 3.2mm PIN prior to

the ANTIROTATION PIN to reduce mis-

targeting. Position the ANTIROTATION

PIN slightly proximal to the center-line

of the femoral neck.

Alternatively, the pin can be placed using

a freehand technique anterior to the nail

andintothefemoralneckandhead.

4, 5

NOTE: Insert 3.2mm pin anterior to the

nail. Inserting them posterior to the nail

may cause damage to the neurovascular

structures.

the PIN in the depth gauge indicates the

length of lag screw to be used.

SlidetheLAGSCREWSTOPASSEMBLY

ontotheLAGSCREWREAMER(Fig.22).

Place the window in the stop over the

number measured with the CANNULATED

LAG SCREW

DEPTHGAUGE(Fig. 23).Ifthe

measurement

wasbetweenmarkingson

the cannulated

depth gauge, set the stop

to the smaller number.

Prior to reaming, manually bend the

ANTIROTATION PIN approximately 30o

away from the path of the 3.2mm PIN.

Attach the LAG SCREW REAMER to the

drill. Ream over the PIN to the level of the

subchondralbone(Fig.24).Whiledrilling,

use the C-arm intermittently to verify

positionofthereamerandtomakesure

that the PIN is not migrating through the

femoral head. Remove the reamer. Push

the end of the PIN while withdrawing the

power tool.

The lag screw is self tapping. If preferred,

tap a hole for the lag screw over the PIN.

The stop can be used to indicate the

appropriate depth gauge.

Select the appropriate length LAG SCREW

based on previous measurements. The

SCREW DEPTH GAUGE can also be used

to verify the length of lag screw that

should be used.

Attach the LAG SCREW to the LAG SCREW

NSERTER using the LAG SCREW RETAINING

SHAFTtofullysecurethescrewtothe

inserter(Fig.25).

Fig. 20

4 AO Principles of Fracture Management, Thieme, 2000

5 Browner et.al., Skeletal Trauma Vol. 2, Basic Science, Management and Reconstruction, p.1929 – 1931, 2003

Zimmer® Natural Nail® System Cephalomedullary Nail Surgical Technique - Standard 9

Fig. 26

Fig. 27

Fig. 28

If compression is planned, thread the

COMPRESSION DEVICE onto the LAG

SCREW INSERTER and twist it to the level

ofthehandle(Fig.26).Thismaybedone

before or after attaching the lag screw.

Insert the LAG SCREW over the PIN

andintothefemur(Fig.27).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). Rotate the LAG SCREW

INSERTER up to 90° in order to correctly

orientthehandletotheguide(Fig.28).

NOTE: Do not 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 perpendicular

to the guide. This reduces the risk

of interference when removing the

ANTIROTATION PIN.

Fig. 29

NOTE: Remove the ANTIROTATION PIN (if

used).

If compression is desired, twist the

COMPRESSIONDEVICEinaclockwise

fashion(Fig.29).

Fig. 30

As the device presses against the

LAG SCREW CANNULA, it will generate

compression across the fracture

(Fig.30).Compressasneededtoreduce

the fracture.

Fig. 31

A SET SCREW (included 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FLEXIBLECAPTUREDSETSCREW

DRIVERor3.5mmHEXSCREWDRIVERinto

the 3.5mm hex end of the SET SCREW

(Fig.31).

The SET SCREW is then passed through

theCONNECTINGBOLTintotheproximal

portionofthenail(Fig.32).

Fig. 32

Zimmer® Natural Nail® System Cephalomedullary Nail Surgical Technique - Standard

NOTE: If using the FLEXIBLE CAPTURED SET

SCREW DRIVER make sure that it is not

used at an angle greater than 40˚. If it is

used at an angle greater than 40˚, it may be

damaged.

NOTE: Do not drive the set screw into the

nail under power as damage to the set

screw or the nail could result.

The SET SCREW should be tightened down

into the groove in the lag screw. As noted

above, the LAG SCREW INSERTER must be

positioned so that the handle on the inserter

is parallel or perpendicular to the colored

dots on the TARGETING GUIDE in order for

the SET SCREW and LAG SCREW grooves

to engage properly. To verify engagement,

attempt to twist the LAG SCREW INSERTER.

If it cannot be rotated 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(Fig.33).

Fig. 33

NOTE: To achieve sliding, tighten

the SET SCREW and then rotate the

FLEXIBLE CAPTURED SET SCREW DRIVER

counterclockwise one quarter turn. Do

not unscrew the SET SCREW more than

one quarter turn. Make sure that the SET

SCREW is still engaged in the groove by

checking that it is still not possible to

turn the LAG SCREW with the LAG SCREW

INSERTER.

Disengage the LAG SCREW INSERTER

fromtheLAGSCREW.A3.5mmHEX

SCREWDRIVER may be used to disengage

theLAGSCREWRETAININGSHAFTfromthe

LAG SCREW.

TECHNIQUE TIP: The LAG SCREW CANNULA

can be left in place to aid in stabilizing the

construct during distal screw placement in

the short nails, if desired (Fig. 34). Remove

the FLEXIBLE CAPTURED SET SCREW DRIVER

and set aside.

Distal Targeting For Short Nails

Color coded instruments are also used

fordistaltargetingofshortnails.Forthe

STANDARD TARGETING GUIDE, instruments

markedGREENareutilizedtoplacethe

distal screws. The chart below details the

color coded instruments that are used for

distal targeting and distal screw placement.

The STANDARD TARGETING GUIDE is

designed to target the distal static

(ST) and dynamic (DY) holes in SHORT

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 targeting holes (left or

right) are used for drilling and screw

placement. At this point in the surgery,

with the guide oriented horizontally

and the nail in place, the correct holes

are on the top (anterior) side of the

guide. A YELLOW CAUTION SYMBOL is

engraved on the face of the guide near

the ST/DY holes to remind the surgeon

to take note of the placement of the

screw. Additionally, the words “LEFT”

and “RIGHT” are embossed in green

on the appropriate side of the guide

where the SCREW CANNULAS should

be placed to insert these screws.

The MODULAR STANDARD TARGETING

GUIDE can not be used to distal target

the short nails.

Assemble the TROCAR to the 8.0mm

CANNULA. Pass the CANNULA through the

appropriate hole in the TARGETING GUIDE

to target the distal hole or slot. The hole is

labeled ST is for the Static Hole. The hole

labeled DY is for the Dynamic Slot.

After pressing the tip of the TROCAR and

CANNULA

againsttheskin,makeasmall

incisionatthatpointthroughtheskinand

fascia lata. Spread the soft tissue down to

the bone. Advance the CANNULA down to

the bone.

CAUTION: Do not impact on the CANNULA

or TROCAR, as the tip of the cannula may

skive along the bone and prevent accurate

targeting.

Remove the TROCAR (if used) and insert the

4,3mm DRILL SLEEVE into the CANNULA.

Utilizethe4.3mmDRILLBITtodrillthrough

both cortices of bone. The depth of the hole

can be measured using calibrations on the

DRILLBIT.Anotheroptionistoremovethe

drill bit and the drill sleeve and then use the

SCREW DEPTH GAUGE to measure the depth

of the hole.

CAUTION: In cases where hard cortical

bone is encountered, or at the surgeon’s

preference, a 5.0mm TAP (00-2490-048-50)

can be used to ease insertion of the screws.

Fig. 34

Instrument Type Standard

8.0mm Screw Cannula Green

4.3mm Drill Sleeve Green–Red

4.3mmDrillBit  Green–Red

Screwdriver Green

Screw Depth Gauge Green

Zimmer® Natural Nail® System Cephalomedullary Nail Surgical Technique - Standard 11

Fig. 34

The nail utilizes a 5.0mm screw distally.

Thescrewpackagesarelabeledwith

the color RED. The distal hole and slot

in the nail allows for standard or fixed

anglelocking.ToachieveSTANDARD

LOCKING, choose a PARTIALLY THREADED

5.0mmSCREW.ToachieveaFIXEDANGLE

construct,chooseaFIXEDANGLE5.0mm

SCREW(Fig35),applicableforlong

nails only). In SHORT nails, either screw

type will result in a STANDARD LOCKING

construct.

Choose the appropriate length screw based

ontheDEPTHGAUGEorDRILLBITreading.

Usethe3.5mmHEXSCREWDRIVERtoplace

the screw bicortically through the bone.

If using the CAPTURED SCREWDRIVER,

place the appropriate screw on the 3.5mm

HEXandtightenthescrewtotheCAPTURED

SCREWDRIVERbyturningtheknobnextto

thehandleclockwise.

CAUTION: If using the CAPTURED SCREW

DRIVER, do not torque the CAPTURED

SCREWDRIVER beyond the calibration line

next to the handle.

CAUTION: Do not drive the screws into the

bone under power, as damage to the bone,

screws and nail could result.

Remove the screwdriver and cannula.

If desired, repeat these steps to place

another screw in the other hole or slot.

If not previously done, remove the LAG

SCREW CANNULA.

Freehand Technique for Long Nails

InserttheFREEHAND4.3mmDRILLBIT

(RED) into the DISTAL TARGETING DEVICE.

FingertightentheSETSCREW.Position

* It is the responsibility of the surgeon to determine what is the most suitable postoperative

care depending on each patient’s health condition.

the C-arm in order to get a lateral view of the

distal femur. Adjust the angle of the C-arm

so that the hole through the nail appears as

aperfectcircleonthemonitor.Bringthetip

ofthedrillbittotheskinandusetheC-arm

to center it over the hole that you desire to

placeascrewthrough.Makeastabwound

at this point and dissect down to the bone.

Place the tip of the drill bit against the bone.

Verify that the tip of the drill bit is in the

center of the hole. Align the drill bit with the

C-arm beam. Tap the 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4.3mm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 appropriate length screw

using the screwdriver.

If using the CAPTURED SCREWDRIVER, place

theappropriatescrewonthe3.5mmHEX

and tighten the screw to the CAPTURED

SCREWDRIVERbyturningtheknobnextto

thehandleclockwise(Fig.36).

CAUTION: If using the CAPTURED SCREW

DRIVER, do not torque the CAPTURED

SCREWDRIVER beyond the calibration line

next to the handle.

CAUTION: Do not drive the screws into the

bone under power, as damage to the bone,

screws and nail could result.

Repeat these steps to insert additional distal

screws.

Final Implant Placement

Observe the depth of the nail in the

proximal femur. Ridges at 5 and 10mm

from the end of the targeting guide barrel

indicate nail depth.

It is recommended to use a NAIL CAP

to close the proximal part of the nail to

prevent bone ingrowth.

Place a 2.0mm GUIDE PIN through the

CONNECTINGBOLTandintotheproximal

portion of the NAIL. Loosen and remove the

CONNECTINGBOLTfromthenailtakingcare

to leave the 2.0mm GUIDE PIN in place. If a

NAIL CAP will not be used, do not introduce

the 2.0mm GUIDE PIN.

TECHNIQUE NOTE: The 0mm 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.

Choose the appropriate height of NAIL

CAP. Secure the selected NAIL CAP to the

NAIL CAP INSERTER using the NAIL CAP

RETAININGSHAFT(Fig.37).

Place the NAIL CAP over the 2.0mm GUIDE

WIRE and thread it into the top of the NAIL.

Using the C-arm, verify that the cap is

completely seated in the top of the nail.

Disengage the NAIL CAP INSERTER from the

NAIL CAP. Remove the 2.0mm GUIDE PIN.

Close all wounds and apply the appropriate

dressings.

Fig. 37

Fig. 36

Fig. 35

Zimmer® Natural Nail® System Cephalomedullary Nail Surgical Technique - Standard

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3.5mmHEX

SCREWDRIVER. Remove the NAIL CAP

(if one was inserted) with a 5.0mm

HEXSCREWDRIVER.Usea3.5mm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 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 the LAG SCREW INSERTER

is fully seated. Hand tighten the LAG

SCREW INSERTER with the 3.5mm HEX

SCREWDRIVER.

To remove the nail, slide a 3.0mm x

100cm GUIDE WIRE through the nail. Insert

the CEPHALOMEDULLARY CANNULATED

EXTRACTIONADAPTERoverthewire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.

Zimmer® Natural Nail® System Cephalomedullary Nail Surgical Technique - Standard 13

Cephalomedullary Long Nail Details

4o Proximal Lateralization Angle

10, 11.5, 13mm

shaft diameters

SpiralFlutes

45 to 50mm from tip

34 to 39mm from tip

17 to 29mm from tip (Dynamic Slot)

Anterior bevel on tip 7 to 12mm from tip

15.5mm Proximal Head

58mm Proximal

Body Length

1275mm

AnteriorBowRadius

Lengths 30 through 34cm

1400mm

AnteriorBowRadius

Lengths 36 through 40cm

1525mm

AnteriorBowRadius

Lengths 42 through 48cm

Lag Screw

10.5mm Diameter

6.6mm Minor Diameter

10.2mm Drill

2.8mm Tip Length

5.0mm Screw

8mm Diameter Head

3.8mm Head Height

4.3mm Minor Diameter

4.3mm Drill

2.0mm Tip Length

35 to 39mm from tip (3.0mm Pin)

42 to 54mm from tip (10.5mm Lag Screw)

Blue Ring

15o Anteversion

125o / 130o/ 135o CCD Angle

Zimmer® Natural Nail® System Cephalomedullary Nail Surgical Technique - Standard

Cephalomedullary Short Nail Details

4o Proximal Lateralization Angle

10, 11.5, 13, 14.5mm shaft diameters

60 to65mm

from tip

43 to 55mm

from tip

(Dynamic Slot)

Clothespin tip (for nails

11.5mm in diameter and larger)

15.5mm Proximal Head

58mm Proximal

Body Length

1275mm

AnteriorBowRadius

35 to 39mm from tip (3.0mm Pin)

42 to 54mm from tip (10.5mm Lag Screw)

Lag Screw

10.5mm Diameter

6.6mm Minor Diameter

10.2mm Drill

2.8mm Tip Length

5.0mm Screw

8mm Diameter Head

3.8mm Head Height

4.3mm Minor Diameter

4.3mm Drill

2.0mm Tip Length

BlueRing

5.0mm

Screws

15o Anteversion

NOTE: There is no locking tab (StabiliZe Technology) for the Cephalomedullary Short Nails.

125o / 130o/ 135o CCD Angle

Zimmer® Natural Nail® System Cephalomedullary Nail Surgical Technique - Standard 15

Item Number Product Description

47-2493-300-10 CephalomedullaryLongNail10mmX30cm125CCDRight

Ti-6Al-4V Alloy

47-2493-301-10 CephalomedullaryLongNail10mmX30cm125CCDLeft

Ti-6Al-4V Alloy

47-2493-302-10 CephalomedullaryLongNail10mmX30cm130CCDRight

Ti-6Al-4V Alloy

47-2493-303-10 CephalomedullaryLongNail10mmX30cm130CCDLeft

Ti-6Al-4V Alloy

47-2493-304-10 CephalomedullaryLongNail10mmX30cm135CCDRight

Ti-6Al-4V Alloy

47-2493-305-10 CephalomedullaryLongNail10mmX30cm135CCDLeft

Ti-6Al-4V Alloy

47-2493-320-10 CephalomedullaryLongNail10mmX32cm125CCDRight

Ti-6Al-4V Alloy

47-2493-321-10 CephalomedullaryLongNail10mmX32cm125CCDLeft

Ti-6Al-4V Alloy

47-2493-322-10 CephalomedullaryLongNail10mmX32cm130CCDRight

Ti-6Al-4V Alloy

47-2493-323-10 CephalomedullaryLongNail10mmX32cm130CCDLeft

Ti-6Al-4V Alloy

47-2493-324-10 CephalomedullaryLongNail10mmX32cm135CCDRight

Ti-6Al-4V Alloy

47-2493-325-10 CephalomedullaryLongNail10mmX32cm135CCDLeft

Ti-6Al-4V Alloy

47-2493-340-10 CephalomedullaryLongNail10mmX34cm125CCDRight

Ti-6Al-4V Alloy

47-2493-341-10 CephalomedullaryLongNail10mmX34cm125CCDLeft

Ti-6Al-4V Alloy

47-2493-342-10 CephalomedullaryLongNail10mmX34cm130CCDRight

Ti-6Al-4V Alloy

47-2493-343-10 CephalomedullaryLongNail10mmX34cm130CCDLeft

Ti-6Al-4V Alloy

47-2493-344-10 CephalomedullaryLongNail10mmX34cm135CCDRight

Ti-6Al-4V Alloy

47-2493-345-10 CephalomedullaryLongNail10mmX34cm135CCDLeft

Ti-6Al-4V Alloy

47-2493-360-10 CephalomedullaryLongNail10mmX36cm125CCDRight

Ti-6Al-4V Alloy

47-2493-361-10 CephalomedullaryLongNail10mmX36cm125CCDLeft

Ti-6Al-4V Alloy

47-2493-362-10 CephalomedullaryLongNail10mmX36cm130CCDRight

Ti-6Al-4V Alloy

47-2493-363-10 CephalomedullaryLongNail10mmX36cm130CCDLeft

Ti-6Al-4V Alloy

47-2493-364-10 CephalomedullaryLongNail10mmX36cm135CCDRight

Ti-6Al-4V Alloy

47-2493-365-10 CephalomedullaryLongNail10mmX36cm135CCDLeft

Ti-6Al-4V Alloy

47-2493-380-10 CephalomedullaryLongNail10mmX38cm125CCDRight

Ti-6Al-4V Alloy

47-2493-381-10 CephalomedullaryLongNail10mmX38cm125CCDLeft

Ti-6Al-4V Alloy

47-2493-382-10 CephalomedullaryLongNail10mmX38cm130CCDRight

Ti-6Al-4V Alloy

47-2493-383-10 CephalomedullaryLongNail10mmX38cm130CCDLeft

Ti-6Al-4V Alloy

47-2493-384-10 CephalomedullaryLongNail10mmX38cm135CCDRight

Ti-6Al-4V Alloy

Cephalomedullary Short Nails

Product Information

Item Number Product Description

47-2493-210-10 CephalomedullaryShortNail10mmX21.5cm125CCD

Right Ti-6Al-4V Alloy

47-2493-211-10 CephalomedullaryShortNail10mmX21.5cm125CCD

Left Ti-6Al-4V Alloy

47-2493-212-10 CephalomedullaryShortNail10mmX21.5cm130CCD

Right Ti-6Al-4V Alloy

47-2493-213-10 CephalomedullaryShortNail10mmX21.5cm130CCD

Left Ti-6Al-4V Alloy

47-2493-214-10 CephalomedullaryShortNail10mmX21.5cm135CCD

Right Ti-6Al-4V Alloy

47-2493-215-10 CephalomedullaryShortNail10mmX21.5cm135CCD

Left Ti-6Al-4V Alloy

47-2493-210-11 CephalomedullaryShortNail11.5mmX21.5cm125CCD

Right Ti-6Al-4V Alloy

47-2493-211-11 CephalomedullaryShortNail11.5mmX21.5cm125CCD

Left Ti-6Al-4V Alloy

47-2493-212-11 CephalomedullaryShortNail11.5mmX21.5cm130CCD

Right Ti-6Al-4V Alloy

47-2493-213-11 CephalomedullaryShortNail11.5mmX21.5cm130CCD

Left Ti-6Al-4V Alloy

47-2493-214-11 CephalomedullaryShortNail11.5mmX21.5cm135CCD

Right Ti-6Al-4V Alloy

47-2493-215-11 CephalomedullaryShortNail11.5mmX21.5cm135CCD

Left Ti-6Al-4V Alloy

47-2493-210-13 CephalomedullaryShortNail13mmX21.5cm125CCD

Right Ti-6Al-4V Alloy

47-2493-211-13 CephalomedullaryShortNail13mmX21.5cm125CCD

Left Ti-6Al-4V Alloy

47-2493-212-13 CephalomedullaryShortNail13mmX21.5cm130CCD

Right Ti-6Al-4V Alloy

47-2493-213-13 CephalomedullaryShortNail13mmX21.5cm130CCD

Left Ti-6Al-4V Alloy

47-2493-214-13 CephalomedullaryShortNail13mmX21.5cm135CCD

Right Ti-6Al-4V Alloy

47-2493-215-13 CephalomedullaryShortNail13mmX21.5cm135CCD

Left Ti-6Al-4V Alloy

47-2493-210-14 CephalomedullaryShortNail14.5mmX21.5cm125CCD

Right Ti-6Al-4V Alloy

47-2493-211-14 CephalomedullaryShortNail14.5mmX21.5cm125CCD

Left Ti-6Al-4V Alloy

47-2493-212-14 CephalomedullaryShortNail14.5mmX21.5cm130CCD

Right Ti-6Al-4V Alloy

47-2493-213-14 CephalomedullaryShortNail14.5mmX21.5cm130CCD

Left Ti-6Al-4V Alloy

47-2493-214-14 CephalomedullaryShortNail14.5mmX21.5cm135CCD

Right Ti-6Al-4V Alloy

47-2493-215-14 CephalomedullaryShortNail14.5mmX21.5cm135CCD

Left Ti-6Al-4V Alloy

Cephalomedullary Long Nails

Zimmer® Natural Nail® System Cephalomedullary Nail Surgical Technique - Standard

47-2493-385-10 CephalomedullaryLongNail10mmX38cm135CCDLeft

Ti-6Al-4V Alloy

47-2493-400-10 CephalomedullaryLongNail10mmX40cm125CCDRight

Ti-6Al-4V Alloy

47-2493-401-10 CephalomedullaryLongNail10mmX40cm125CCDLeft

Ti-6Al-4V Alloy

47-2493-402-10 CephalomedullaryLongNail10mmX40cm130CCDRight

Ti-6Al-4V Alloy

47-2493-403-10 CephalomedullaryLongNail10mmX40cm130CCDLeft

Ti-6Al-4V Alloy

47-2493-404-10 CephalomedullaryLongNail10mmX40cm135CCDRight

Ti-6Al-4V Alloy

47-2493-405-10 CephalomedullaryLongNail10mmX40cm135CCDLeft

Ti-6Al-4V Alloy

47-2493-420-10 CephalomedullaryLongNail10mmX42cm125CCDRight

Ti-6Al-4V Alloy

47-2493-421-10 CephalomedullaryLongNail10mmX42cm125CCDLeft

Ti-6Al-4V Alloy

47-2493-422-10 CephalomedullaryLongNail10mmX42cm130CCDRight

Ti-6Al-4V Alloy

47-2493-423-10 CephalomedullaryLongNail10mmX42cm130CCDLeft

Ti-6Al-4V Alloy

47-2493-424-10 CephalomedullaryLongNail10mmX42cm135CCDRight

Ti-6Al-4V Alloy

47-2493-425-10 CephalomedullaryLongNail10mmX42cm135CCDLeft

Ti-6Al-4V Alloy

47-2493-440-10 CephalomedullaryLongNail10mmX44cm125CCDRight

Ti-6Al-4V Alloy

47-2493-441-10 CephalomedullaryLongNail10mmX44cm125CCDLeft

Ti-6Al-4V Alloy

47-2493-442-10 CephalomedullaryLongNail10mmX44cm130CCDRight

Ti-6Al-4V Alloy

47-2493-443-10 CephalomedullaryLongNail10mmX44cm130CCDLeft

Ti-6Al-4V Alloy

47-2493-444-10 CephalomedullaryLongNail10mmX44cm135CCDRight

Ti-6Al-4V Alloy

47-2493-445-10 CephalomedullaryLongNail10mmX44cm135CCDLeft

Ti-6Al-4V Alloy

47-2493-460-10 CephalomedullaryLongNail10mmX46cm125CCDRight

Ti-6Al-4V Alloy

47-2493-461-10 CephalomedullaryLongNail10mmX46cm125CCDLeft

Ti-6Al-4V Alloy

47-2493-462-10 CephalomedullaryLongNail10mmX46cm130CCDRight

Ti-6Al-4V Alloy

47-2493-463-10 CephalomedullaryLongNail10mmX46cm130CCDLeft

Ti-6Al-4V Alloy

47-2493-464-10 CephalomedullaryLongNail10mmX46cm135CCDRight

Ti-6Al-4V Alloy

47-2493-465-10 CephalomedullaryLongNail10mmX46cm135CCDLeft

Ti-6Al-4V Alloy

47-2493-480-10 CephalomedullaryLongNail10mmX48cm125CCDRight

Ti-6Al-4V Alloy

47-2493-481-10 CephalomedullaryLongNail10mmX48cm125CCDLeft

Ti-6Al-4V Alloy

47-2493-482-10 CephalomedullaryLongNail10mmX48cm130CCDRight

Ti-6Al-4V Alloy

47-2493-483-10 CephalomedullaryLongNail10mmX48cm130CCDLeft

Ti-6Al-4V Alloy

47-2493-484-10 CephalomedullaryLongNail10mmX48cm135CCDRight

Ti-6Al-4V Alloy

47-2493-485-10 CephalomedullaryLongNail10mmX48cm135CCDLeft

Ti-6Al-4V Alloy

47-2493-300-11 CephalomedullaryLongNail11.5mmX30cm125CCD

Right Ti-6Al-4V Alloy

47-2493-301-11 CephalomedullaryLongNail11.5mmX30cm125CCD

Left Ti-6Al-4V Alloy

47-2493-302-11 CephalomedullaryLongNail11.5mmX30cm130CCD

Right Ti-6Al-4V Alloy

47-2493-303-11 CephalomedullaryLongNail11.5mmX30cm130CCD

Left Ti-6Al-4V Alloy

47-2493-304-11 CephalomedullaryLongNail11.5mmX30cm135CCD

Right Ti-6Al-4V Alloy

47-2493-305-11 CephalomedullaryLongNail11.5mmX30cm135CCD

Left Ti-6Al-4V Alloy

47-2493-320-11 CephalomedullaryLongNail11.5mmX32cm125CCD

Right Ti-6Al-4V Alloy

47-2493-321-11 CephalomedullaryLongNail11.5mmX32cm125CCD

Left Ti-6Al-4V Alloy

47-2493-322-11 CephalomedullaryLongNail11.5mmX32cm130CCD

Right Ti-6Al-4V Alloy

47-2493-323-11 CephalomedullaryLongNail11.5mmX32cm130CCD

Left Ti-6Al-4V Alloy

47-2493-324-11 CephalomedullaryLongNail11.5mmX32cm135CCD

Right Ti-6Al-4V Alloy

47-2493-325-11 CephalomedullaryLongNail11.5mmX32cm135CCD

Left Ti-6Al-4V Alloy

47-2493-340-11 CephalomedullaryLongNail11.5mmX34cm125CCD

Right Ti-6Al-4V Alloy

47-2493-341-11 CephalomedullaryLongNail11.5mmX34cm125CCD

Left Ti-6Al-4V Alloy

47-2493-342-11 CephalomedullaryLongNail11.5mmX34cm130CCD

Right Ti-6Al-4V Alloy

47-2493-343-11 CephalomedullaryLongNail11.5mmX34cm130CCD

Left Ti-6Al-4V Alloy

47-2493-344-11 CephalomedullaryLongNail11.5mmX34cm135CCD

Right Ti-6Al-4V Alloy

47-2493-345-11 CephalomedullaryLongNail11.5mmX34cm135CCD

Left Ti-6Al-4V Alloy

47-2493-360-11 CephalomedullaryLongNail11.5mmX36cm125CCD

Right Ti-6Al-4V Alloy

47-2493-361-11 CephalomedullaryLongNail11.5mmX36cm125CCD

Left Ti-6Al-4V Alloy

47-2493-362-11 CephalomedullaryLongNail11.5mmX36cm130CCD

Right Ti-6Al-4V Alloy

47-2493-363-11 CephalomedullaryLongNail11.5mmX36cm130CCD

Left Ti-6Al-4V Alloy

47-2493-364-11 CephalomedullaryLongNail11.5mmX36cm135CCD

Right Ti-6Al-4V Alloy

47-2493-365-11 CephalomedullaryLongNail11.5mmX36cm135CCD

Left Ti-6Al-4V Alloy

47-2493-380-11 CephalomedullaryLongNail11.5mmX38cm125CCD

Right Ti-6Al-4V Alloy

47-2493-381-11 CephalomedullaryLongNail11.5mmX38cm125CCD

Left Ti-6Al-4V Alloy

47-2493-382-11 CephalomedullaryLongNail11.5mmX38cm130CCD

Right Ti-6Al-4V Alloy

47-2493-383-11 CephalomedullaryLongNail11.5mmX38cm130CCD

Left Ti-6Al-4V Alloy

47-2493-384-11 CephalomedullaryLongNail11.5mmX38cm135CCD

Right Ti-6Al-4V Alloy

Zimmer® Natural Nail® System Cephalomedullary Nail Surgical Technique - Standard 17

47-2493-485-11 CephalomedullaryLongNail11.5mmX48cm135CCD

Left Ti-6Al-4V Alloy

47-2493-300-13 CephalomedullaryLongNail13mmX30cm125CCDRight

Ti-6Al-4V Alloy

47-2493-301-13 CephalomedullaryLongNail13mmX30cm125CCDLeft

Ti-6Al-4V Alloy

47-2493-302-13 CephalomedullaryLongNail13mmX30cm130CCDRight

Ti-6Al-4V Alloy

47-2493-303-13 CephalomedullaryLongNail13mmX30cm130CCDLeft

Ti-6Al-4V Alloy

47-2493-304-13 CephalomedullaryLongNail13mmX30cm135CCDRight

Ti-6Al-4V Alloy

47-2493-305-13 CephalomedullaryLongNail13mmX30cm135CCDLeft

Ti-6Al-4V Alloy

47-2493-320-13 CephalomedullaryLongNail13mmX32cm125CCDRight

Ti-6Al-4V Alloy

47-2493-321-13 CephalomedullaryLongNail13mmX32cm125CCDLeft

Ti-6Al-4V Alloy

47-2493-322-13 CephalomedullaryLongNail13mmX32cm130CCDRight

Ti-6Al-4V Alloy

47-2493-323-13 CephalomedullaryLongNail13mmX32cm130CCDLeft

Ti-6Al-4V Alloy

47-2493-324-13 CephalomedullaryLongNail13mmX32cm135CCDRight

Ti-6Al-4V Alloy

47-2493-325-13 CephalomedullaryLongNail13mmX32cm135CCDLeft

Ti-6Al-4V Alloy

47-2493-340-13 CephalomedullaryLongNail13mmX34cm125CCDRight

Ti-6Al-4V Alloy

47-2493-341-13 CephalomedullaryLongNail13mmX34cm125CCDLeft

Ti-6Al-4V Alloy

47-2493-342-13 CephalomedullaryLongNail13mmX34cm130CCDRight

Ti-6Al-4V Alloy

47-2493-343-13 CephalomedullaryLongNail13mmX34cm130CCDLeft

Ti-6Al-4V Alloy

47-2493-344-13 CephalomedullaryLongNail13mmX34cm135CCDRight

Ti-6Al-4V Alloy

47-2493-345-13 CephalomedullaryLongNail13mmX34cm135CCDLeft

Ti-6Al-4V Alloy

47-2493-360-13 CephalomedullaryLongNail13mmX36cm125CCDRight

Ti-6Al-4V Alloy

47-2493-361-13 CephalomedullaryLongNail13mmX36cm125CCDLeft

Ti-6Al-4V Alloy

47-2493-362-13 CephalomedullaryLongNail13mmX36cm130CCDRight

Ti-6Al-4V Alloy

47-2493-363-13 CephalomedullaryLongNail13mmX36cm130CCDLeft

Ti-6Al-4V Alloy

47-2493-364-13 CephalomedullaryLongNail13mmX36cm135CCDRight

Ti-6Al-4V Alloy

47-2493-365-13 CephalomedullaryLongNail13mmX36cm135CCDLeft

Ti-6Al-4V Alloy

47-2493-380-13 CephalomedullaryLongNail13mmX38cm125CCDRight

Ti-6Al-4V Alloy

47-2493-381-13 CephalomedullaryLongNail13mmX38cm125CCDLeft

Ti-6Al-4V Alloy

47-2493-382-13 CephalomedullaryLongNail13mmX38cm130CCDRight

Ti-6Al-4V Alloy

47-2493-383-13 CephalomedullaryLongNail13mmX38cm130CCDLeft

Ti-6Al-4V Alloy

47-2493-384-13 CephalomedullaryLongNail13mmX38cm135CCDRight

Ti-6Al-4V Alloy

47-2493-385-11 CephalomedullaryLongNail11.5mmX38cm135CCD

Left Ti-6Al-4V Alloy

47-2493-400-11 CephalomedullaryLongNail11.5mmX40cm125CCD

Right Ti-6Al-4V Alloy

47-2493-401-11 CephalomedullaryLongNail11.5mmX40cm125CCD

Left Ti-6Al-4V Alloy

47-2493-402-11 CephalomedullaryLongNail11.5mmX40cm130CCD

Right Ti-6Al-4V Alloy

47-2493-403-11 CephalomedullaryLongNail11.5mmX40cm130CCD

Left Ti-6Al-4V Alloy

47-2493-404-11 CephalomedullaryLongNail11.5mmX40cm135CCD

Right Ti-6Al-4V Alloy

47-2493-405-11 CephalomedullaryLongNail11.5mmX40cm135CCD

Left Ti-6Al-4V Alloy

47-2493-420-11 CephalomedullaryLongNail11.5mmX42cm125CCD

Right Ti-6Al-4V Alloy

47-2493-421-11 CephalomedullaryLongNail11.5mmX42cm125CCD

Left Ti-6Al-4V Alloy

47-2493-422-11 CephalomedullaryLongNail11.5mmX42cm130CCD

Right Ti-6Al-4V Alloy

47-2493-423-11 CephalomedullaryLongNail11.5mmX42cm130CCD

Left Ti-6Al-4V Alloy

47-2493-424-11 CephalomedullaryLongNail11.5mmX42cm135CCD

Right Ti-6Al-4V Alloy

47-2493-425-11 CephalomedullaryLongNail11.5mmX42cm135CCD

Left Ti-6Al-4V Alloy

47-2493-440-11 CephalomedullaryLongNail11.5mmX44cm125CCD

Right Ti-6Al-4V Alloy

47-2493-441-11 CephalomedullaryLongNail11.5mmX44cm125CCD

Left Ti-6Al-4V Alloy

47-2493-442-11 CephalomedullaryLongNail11.5mmX44cm130CCD

Right Ti-6Al-4V Alloy

47-2493-443-11 CephalomedullaryLongNail11.5mmX44cm130CCD

Left Ti-6Al-4V Alloy

47-2493-444-11 CephalomedullaryLongNail11.5mmX44cm135CCD

Right Ti-6Al-4V Alloy

47-2493-445-11 CephalomedullaryLongNail11.5mmX44cm135CCD

Left Ti-6Al-4V Alloy

47-2493-460-11 CephalomedullaryLongNail11.5mmX46cm125CCD

Right Ti-6Al-4V Alloy

47-2493-461-11 CephalomedullaryLongNail11.5mmX46cm125CCD

Left Ti-6Al-4V Alloy

47-2493-462-11 CephalomedullaryLongNail11.5mmX46cm130CCD

Right Ti-6Al-4V Alloy

47-2493-463-11 CephalomedullaryLongNail11.5mmX46cm130CCD

Left Ti-6Al-4V Alloy

47-2493-464-11 CephalomedullaryLongNail11.5mmX46cm135CCD

Right Ti-6Al-4V Alloy

47-2493-465-11 CephalomedullaryLongNail11.5mmX46cm135CCD

Left Ti-6Al-4V Alloy

47-2493-480-11 CephalomedullaryLongNail11.5mmX48cm125CCD

Right Ti-6Al-4V Alloy

47-2493-481-11 CephalomedullaryLongNail11.5mmX48cm125CCD

Left Ti-6Al-4V Alloy

47-2493-482-11 CephalomedullaryLongNail11.5mmX48cm130CCD

Right Ti-6Al-4V Alloy

47-2493-483-11 CephalomedullaryLongNail11.5mmX48cm130CCD

Left Ti-6Al-4V Alloy

47-2493-484-11 CephalomedullaryLongNail11.5mmX48cm135CCD

Right Ti-6Al-4V Alloy

Zimmer® Natural Nail® System Cephalomedullary Nail Surgical Technique - Standard

47-2493-385-13 CephalomedullaryLongNail13mmX38cm135CCDLeft

Ti-6Al-4V Alloy

47-2493-400-13 CephalomedullaryLongNail13mmX40cm125CCDRight

Ti-6Al-4V Alloy

47-2493-401-13 CephalomedullaryLongNail13mmX40cm125CCDLeft

Ti-6Al-4V Alloy

47-2493-402-13 CephalomedullaryLongNail13mmX40cm130CCDRight

Ti-6Al-4V Alloy

47-2493-403-13 CephalomedullaryLongNail13mmX40cm130CCDLeft

Ti-6Al-4V Alloy

47-2493-404-13 CephalomedullaryLongNail13mmX40cm135CCDRight

Ti-6Al-4V Alloy

47-2493-405-13 CephalomedullaryLongNail13mmX40cm135CCDLeft

Ti-6Al-4V Alloy

47-2493-420-13 CephalomedullaryLongNail13mmX42cm125CCDRight

Ti-6Al-4V Alloy

47-2493-421-13 CephalomedullaryLongNail13mmX42cm125CCDLeft

Ti-6Al-4V Alloy

47-2493-422-13 CephalomedullaryLongNail13mmX42cm130CCDRight

Ti-6Al-4V Alloy

47-2493-423-13 CephalomedullaryLongNail13mmX42cm130CCDLeft

Ti-6Al-4V Alloy

47-2493-424-13 CephalomedullaryLongNail13mmX42cm135CCDRight

Ti-6Al-4V Alloy

47-2493-425-13 CephalomedullaryLongNail13mmX42cm135CCDLeft

Ti-6Al-4V Alloy

47-2493-440-13 CephalomedullaryLongNail13mmX44cm125CCDRight

Ti-6Al-4V Alloy

47-2493-441-13 CephalomedullaryLongNail13mmX44cm125CCDLeft

Ti-6Al-4V Alloy

47-2493-442-13 CephalomedullaryLongNail13mmX44cm130CCDRight

Ti-6Al-4V Alloy

47-2493-443-13 CephalomedullaryLongNail13mmX44cm130CCDLeft

Ti-6Al-4V Alloy

47-2493-444-13 CephalomedullaryLongNail13mmX44cm135CCDRight

Ti-6Al-4V Alloy

47-2493-445-13 CephalomedullaryLongNail13mmX44cm135CCDLeft

Ti-6Al-4V Alloy

47-2493-460-13 CephalomedullaryLongNail13mmX46cm125CCDRight

Ti-6Al-4V Alloy

47-2493-461-13 CephalomedullaryLongNail13mmX46cm125CCDLeft

Ti-6Al-4V Alloy

47-2493-462-13 CephalomedullaryLongNail13mmX46cm130CCDRight

Ti-6Al-4V Alloy

47-2493-463-13 CephalomedullaryLongNail13mmX46cm130CCDLeft

Ti-6Al-4V Alloy

47-2493-464-13 CephalomedullaryLongNail13mmX46cm135CCDRight

Ti-6Al-4V Alloy

47-2493-465-13 CephalomedullaryLongNail13mmX46cm135CCDLeft

Ti-6Al-4V Alloy

47-2493-480-13 CephalomedullaryLongNail13mmX48cm125CCDRight

Ti-6Al-4V Alloy

47-2493-481-13 CephalomedullaryLongNail13mmX48cm125CCDLeft

Ti-6Al-4V Alloy

47-2493-482-13 CephalomedullaryLongNail13mmX48cm130CCDRight

Ti-6Al-4V Alloy

47-2493-483-13 CephalomedullaryLongNail13mmX48cm130CCDLeft

Ti-6Al-4V Alloy

47-2493-484-13 CephalomedullaryLongNail13mmX48cm135CCDRight

Ti-6Al-4V Alloy

47-2493-485-13 CephalomedullaryLongNail13mmX48cm135CCDLeft

Ti-6Al-4V Alloy

Item Number Product Description

47-2485-070-10 10.5mm Lag Screw 70mm Length Ti-6Al-4V Alloy

47-2485-075-10 10.5mm Lag Screw 75mm Length Ti-6Al-4V Alloy

47-2485-080-10 10.5mm Lag Screw 80mm Length Ti-6Al-4V Alloy

47-2485-085-10 10.5mm Lag Screw 85mm Length Ti-6Al-4V Alloy

47-2485-090-10 10.5mm Lag Screw 90mm Length Ti-6Al-4V Alloy

47-2485-095-10 10.5mm Lag Screw 95mm Length Ti-6Al-4V Alloy

47-2485-100-10 10.5mm Lag Screw 100mm Length Ti-6Al-4V Alloy

47-2485-105-10 10.5mm Lag Screw 105mm Length Ti-6Al-4V Alloy

47-2485-110-10 10.5mm Lag Screw 110mm Length Ti-6Al-4V Alloy

47-2485-115-10 10.5mm Lag Screw 115mm Length Ti-6Al-4V Alloy

47-2485-120-10 10.5mm Lag Screw 120mm Length Ti-6Al-4V Alloy

47-2485-125-10 10.5mm Lag Screw 125mm Length Ti-6Al-4V Alloy

47-2485-130-10 10.5mm Lag Screw 130mm Length Ti-6Al-4V Alloy

10.5mm Lag Screws

Item Number Product Description

47-2483-020-50 5.0mm Cortical Screw 20mm Length Ti-6Al-4V Alloy