Zimmer® Natural Nail® System Retrograde Femoral Nail Zimmer Surgical Technique

2016-04-04

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Zimmer
Natural Nail
System
®

Retrograde Femoral Nail
Surgical Technique

Zimmer® Natural Nail® System - Retrograde Femoral Nail

Zimmer Natural Nail
System Retrograde Femur
Nail Surgical Technique

Table of Contents
Product Overview

Implant Overview

Indications 2
Contraindications 2
Surgical Technique

Preoperative Planning

Patient Positioning

Reduction 3
Starting Point Location

Distal Reaming

Shaft Reaming

Implant Selection

Nail Assembly and Insertion

Distal Screw Placement

Proximal Screw Placement: Short Nails

Proximal Screw Placement: Freehand Technique for Long Nails 12
Final Implant Placement

Postoperative Care

Nail Extraction

Retrograde Femur Long Nail Details

Retrograde Femur Short Nail Details

Product Information

Zimmer® Natural Nail® System - Retrograde Femoral Nail

Product Overview
The Zimmer Natural Nail System
is a system of intramedullary (IM)
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 Retrograde Femur nail is designed to
help treat various fractures of the femur.
Screws are placed through the nail to
secure the implant in place and maintain
length and alignment while healing
occurs. The nail has multiple screw holes
in the distal body to allow surgeons to
address different fracture types. The
proximal slot allows for compression or
dynamization across a fracture.

Screw Type: Fixed Angle Screws
Proximal Screw Diameter: 5.0mm for all
diameter nails
Proximal Screw Lengths: 20 to 60mm in
2.5mm increments
Screw Type: Fixed Angle Screws and
Partially Threaded Screws
Further available: nail caps (0mm, 5mm,
10mm and 15mm height), cortical nut
and washer
Materials: Ti-6Al-4V Alloy and UHMWPE
(cortical nut only)

Several lengths and diameters are
available to match the individual
anatomy of the patient.

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 universal
instruments are not color coded. The
color coding system is referenced in the
technique. A wall chart (97-2494-00300) is also available to help explain the
color coding system.

Implant Overview

Indications

Nail Diameters: 10, 11.5 and 13mm for
short and long nails

The Zimmer Natural Nail System is
intended for temporary fracture fixation
and stabilization of the bone.

Nail Lengths: 16, 20 and 24cm for
short nails
28 to 44cm in 2cm increments for
long nails

Indications for use of the Retrograde
Femur Nails in the femur including:

• Severely comminuted supracondylar
fractures with articular involvement
• Fractures involving femoral condyles
• Comminuted fractures
• Fractures involving osteopenic and
osteoporotic bone
• Pathological fractures
• Fractures with bone loss
• Pseudoarthrosis, non-union, and
mal-union
• Periprosthetic fractures
• Poly trauma patients

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

• Compound and simple shaft fractures

• Skeletally immature patients

Distal Screw Diameter: 6.0mm for
Oblique Interlocking and Transverse
Interlocking Screws

• Proximal, metaphyseal, and distal
shaft fractures

Distal Screw Lengths: 30 to 110mm in
5mm increments.

• Closed Supracondylar Fractures

This nail should only be used to treat
a periprothetic 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. The
nail will pass through an in situ opening
device greater than 13mm.

• Segmental fractures

Zimmer® Natural Nail® System - Retrograde Femoral Nail

Surgical Technique
Preoperative Planning
Preoperative planning is recommended
before beginning the surgical procedure.
A/P and Lateral x-rays 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.

Patient Positioning
Place the patient in the supine position
with the knee flexed approximately
30 - 60 degrees. Prep the hip limb free,
circumferentially from the hemi pelvis to
the toes, to ensure access to the lesser
trochanter.

The use of a traction or fracture table
can be beneficial to help during
fracture reduction as well as to facilitate
intraoperative imaging with a C-arm.
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 length. Confirm
visualization of the hip as well as the
shaft of the femur and knee using image
intensification before prepping and
draping.

Insert the guide pin in the starting point.
Guide the pin to the notch region using
gentle pressure to avoid scoring of the
articular cartilage (Fig. 1).

Reduction
Nail insertion is facilitated by achieving
fracture reduction before beginning
any of the steps to place the IM Nail.
Traction should be used as necessary to
help achieve fracture reduction. Several
instruments are available to assist in
fracture reduction including clamps,
reduction tongs, ball spike pushers and
Steinman pins. Blocking screws are
another option in facilitating fracture
reduction and and ideal nail path.

Starting Point Location
Locating the entry portal is important
to avoid anterior placement of the nail,
involvement of the intercondylar notch,
femoral trochlea, mediolateral
mal-positioning, or posterior positioning
involving the posterior cruciate
ligaments.
Make a midline or medial parapatellar
longitudinal incision in line with the
femoral shaft. Incise the parapatellar
reticulum or peritenon to expose the
infrapatellar fat pad. It is not necessary
to expose the femoral condyles as
placement of the pin is determined
under C-arm control.

Fig. 1

Use the C-arm to visualize the pin’s
position from an A/P, intercondylar
notch and Lateral views. 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. This can also be confirmed
on the intercondylar notch view.
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 collinearly, with the femoral
canal on both AP and lateral images.
Continue to monitor the pins alignment
and progression (A/P and lateral C-arm
views) as the pin is advanced.
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.

Zimmer® Natural Nail® System - Retrograde Femoral Nail

As an option to insert the guide pin,
assemble the STARTING POINT LOCATOR
inside the ENTRY CANNULA. Place the tip
of the STARTING POINT LOCATOR through
the incision down to the intercondylar
notch. Place the 3.0mm PIN through
the center hole of the STARTING POINT
LOCATOR. Use the steps indicated above
to obtain the correct starting point using
the C-arm (Fig. 2).

Alternatively, a 13.5mm TAPER REAMER
or SHORT CANNULATED AWL can be used
to initiate the entry portal. Do not place
the SHORT CANNULATED AWL over the
3.0mm pin (Fig. 4).

The GUIDE WIRE must be placed through
the fracture site. At the fracture site,
manipulate the GUIDE WIRE under C-arm
control. If you plan to ream the canal
of the femur, the guide wire should be
embedded in the proximal femur canal
using the GUIDE WIRE GRIPPER and a
MALLET (Fig. 5).

Fig. 4

Fig. 2

Use the 8mm ENTRY REAMER to ream an
entry portal over the guide pin into the
distal femur through the starting point.
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. Stop reaming when reduced
resistance is felt. Remove the reamer and
3.0mm pin (Fig. 3).

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.

Place a 3.0mm x 100cm GUIDE WIRE
through the ENTRY CANNULA, all the
way into the proximal femur. To aid in
manipulation, bend the tip of the guide
wire at about a 10 degree angle 5cm
from the end.

A REDUCTION FINGER is included in the
set. The GUIDE WIRE can be fed retrograde
through the REDUCTION FINGER. The
REDUCTION FINGER can then be placed
into the femur and used to help reduce the
fracture from the inside as well as to help
facilitate passage of the guide wire across
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 (16cm, 20cm or 24cm in length).

CAUTION: If the guide wire is bent
shorter than 5cm from the end of the
wire and/or more than 10 degrees it

Fig. 6

Fig. 6a

Fig. 3

Fig. 5

Zimmer® Natural Nail® System - Retrograde Femoral Nail

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
intercondylar notch (confirm position
using fluoroscopy). The distal 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
(Figs. 6 and 6a).

Fig. 7
Fig. 7a

NOTE: This corresponds to the measurement
of the nail depth using the NAIL DEPTH
GAUGE and CONNECTING BOLT. Also, the
measurements correlate to the approximate
height of the nail cap if desired.

Shaft Reaming
Reaming should be performed through
the ENTRY CANNULA. Start with a small
Zimmer® Pressure Sentinal® Reamer.
Increase the diameter of the reamer by
0.5 - 1.0mm depending on the amount
of resistance felt while reaming. When
cortical chatter occurs, stop reaming.
Choose a nail that is 1.0 - 1.5mm smaller
than the last shaft reamer used. If a short
nail is to be used, it is only necessary
to ream the distal portion of the canal
(depending on intended nail length). 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 (Fig. 8).
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
Choose the appropriate length and
diameter of nail based on length and
diameter measurement (fluoroscopic or
based upon the last size reamer used).
If the length indicated is between two
available nail sizes, it is recommended
that the shorter nail be chosen. The nail
tip should not extend proximal to the
intertrochanteric region.
(For the OPTIONAL Modular Guide: Prior
to attaching the nail to the guide, remove
the modules) See Figure 9.

Fig. 9

Nail Assembly and Insertion
The color code for the retrograde femur
nails is PURPLE. Ti-6Al-4V Alloy nails, the
TARGETING GUIDE and the CONNECTING
BOLT all have PURPLE colors on them, as
well as the word PURPLE etched on them
(Fig. 10).

Distal Reaming
Use the 13.5mm TAPER REAMER
(PURPLE) through the ENTRY CANNULA
to prepare the distal femur for the distal
portion of the nail. The C-arm should be
used to visualize the depth of the reamer
in the distal 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 (Figs. 7 and 7a).

Fig. 8

The 13.5mm TAPER REAMER has a groove
on it. The most proximal groove indicates
the final position of the most distal
portion of the nail.
Fig. 10

Zimmer® Natural Nail® System - Retrograde Femoral Nail

Place the CONNECTING BOLT through
the barrel of the TARGETING GUIDE.
Begin threading the CONNECTING BOLT
into the distal portion of the nail. Orient
the distal 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.
The arrow on the nail will line up with the
arrow on the barrel of the guide when the
nail is correctly aligned. The bow of the
nail should be anterior to match the bow
in the femur (Fig. 11).
If using the 00-2490-004-30 RETROGRADE
FEMORAL MODULAR TARGET GUIDE attach
the 00-2490-004-31 RETROGRADE
FEMORAL MODULAR TARGET and/or
GUIDE MODULE LEFT 00-2490-00432 RETROGRADE FEMORAL MODULAR
TARGET GUIDE MODULE RIGHT to confirm
that the guide holes target the nail holes.

Use a screw cannula, drill sleeve and drill
bit to verify that the holes in the guide
target the holes in the nail. If using a
SHORT NAIL, the appropriate PROXIMAL
TARGETING MODULE should be attached
to verify that the drills line up with the
proximal holes in the nail. Remove the
PROXIMAL TARGETING MODULE before
inserting the nail (Fig. 12).

If the nail does not pass down the canal
easily, attach the IMPACTION HEAD to the
CONNECTING BOLT. Using the MALLET,
impact gently on the IMPACTION HEAD
(Fig. 14).

Fig. 12

Fig. 14

Insert the nail over the guide wire.
Monitor the progression of the nail
using the C-arm, especially as the nail is
passing through or near the fracture site
(Fig. 13).

CAUTION: Do not strike excessively as
damage to the guide and the bone may
result. Verify that the CONNECTING BOLT
is tight while impacting. Do not impact
on any other 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.

Fig. 11

Fig. 13

Zimmer® Natural Nail® System - Retrograde Femoral Nail

Remove the GUIDE WIRE from the
nail using the GUIDE WIRE GRIPPER.
If possible, the guide wire should be
removed before the nail is completely
seated to reduce the potential for the
wire to get caught in the nail or bone
being impacted into the cannula of the
nail (Fig. 15).

PROTECTIVE CAP over the distal end of
the NAIL DEPTH GAUGE. The IMPACTION
HEAD must remain assembled to the
CONNECTING BOLT in case the nail depth
needs to be adjusted. Compare the
distal tip of the RETROGRADE FEMUR
NAIL DEPTH GAUGE with the calibrated
etch lines on the CONNECTING BOLT to
determine nail depth. Confirm the depth
using a lateral x-ray. The nail depth is
a result of the depth prepared with the
13.5MM TAPER REAMER. If oblique
screws are to be used, verification of nail
depth is critical. To facilitate observation
of nail depth using fluoroscopy, the
C-Arm can be tilted 5-15 degrees off of
the true lateral plane to verify the end
of the nail to the Blumensatt’s Line.
A perfect circle should be observed
through the transverse hole to ensure
proper orientation (Fig. 16).

Fig. 17

Fig. 15

Note: If guide wire gets stuck during
removal, rotate wire 90 degrees as
force is applied to remove. This can be
accomplished by using the Guide Wire
Gripper.
It is recommended that the distal tip
of the nail be placed 3-5mm inside the
distal surface of the femur. However, the
nail can be placed deeper and nail cap
used to fill femoral canal. To verify depth,
advance the NAIL DEPTH GAUGE through
the guide. The NAIL DEPTH GAUGE
must be assembled before attaching
the IMPACTION HEAD. To ensure the
NAIL DEPTH GAUGE does not slide into
the femoral canal opening, place a blue

Nail rotation is also critical with this nail
and should be verified by placing 3.0mm
PINS through the holes in the targeting
guide on either side of the connecting
bolt. Place the blue PROTECTIVE CAPS
on the pointed end of the 3.0mm PINS
before inserting into the Targeting Guide
to prevent them from falling on the floor.
Rotate the guide so that the pins are
parallel with the tibia shaft (Fig. 17).

Fig. 16

Zimmer® Natural Nail® System - Retrograde Femoral Nail

Distal Screw Placement
Use only 6.0mm FIXED ANGLE screws
through the appropriate distal holes in
the nail.
A fixed angle construct is created by
using 6.0mm fixed angle screws. The
instruments needed to place screws
through the distal portion of the nail are
color coded according to the chart below.
The retrograde femur guides use the
PURPLE instruments.
Insrument Type

Standard

Screw Cannula

Purple

Trocar/Tri-Flute Trocar

Purple

4.9mm Drill Sleeve

Purple/Black

4.9mm Drill Bit
(solid or cannulated)

Purple/Black

3.0mm Pin Sleeve

Purple

Screw Depth Gauge/
Cannulated Screw
Depth Gauge

Purple

Screwdriver

Purple

Note: 6.0mm fixed angle screws contain
the color/color name of BLACK on the
label and screw case. These colors
match the color rings on the drills.

(For the Optional Modular Guide: Attach
the modules to the guide for the distal
screw targeting. Do NOT impact on the
guide while the modules are attached).
See Figure 19.

Fig. 20

Fig. 19

Only certain distal screw patterns
should be used. Use of all other screw
combinations may subject the device
to increased stresses, which could lead
to device failure. Please choose the
appropriate screw pattern from the table
below. These screw patterns are also
depicted on the targeting guide (Fig. 20).

Before placing any oblique screws, place
3.0mm PINS through the pin holes in the
targeting arms. Use the blue pin caps to
secure the pins in the holes. Place the
blue pin caps on the pointed end of the
3.0mm PINS. Take a lateral x-ray. The
position of the pins on the lateral x-ray
represents where the oblique screws will
be placed. If lateral imaging is difficult,
incline the C-arm beam 5 – 15 degrees
off the horizontal. The 3.0mm PINS
must be contained in the metaphyseal
region in any imaging in any plane. The
most distal transverse hole has to be
imaged as a perfect circle (Fig. 21).

If impaction was required, retighten the
CONNECTING BOLT to the nail (Fig. 18).

Fig. 21

Fig. 18

Two factors will primarily affect the
location of the two oblique screws: nail
insertion depth and nail rotation. It is
recommended that nail insertion depth
be adjusted first and then rotation of the
nail/targeting guide.

Zimmer® Natural Nail® System - Retrograde Femoral Nail

For Transverse Screws

If a WASHER (can be used at any distal
hole) or CORTICAL NUT (used only at
most distal transverse hole) is desired,
please refer to the steps for placing these
items below.
After confirming appropriate nail
insertion depth and rotation, it is
suggested that the 3.0mm PIN be placed
in one of the transverse holes. This will
stabilize the nail and targeting guide in
the selected position.
Slide the TROCAR into the SCREW
CANNULA. Slide the SCREW CANNULA
through one of the transverse holes in
the TARGETING MODULE. Incise the
skin at the point the TROCAR touches
it and dissect through the tissue down
to the bone to make a path for the
SCREW CANNULA. Advance the SCREW
CANNULA until the tip of the TROCAR is
against the bone (Fig. 22).

Fig. 23

Remove the TROCAR. Before drilling,
use the PIN SLEEVE and drive in a guide
pin to preview targeting via fluoroscopy.
Confirm the rotational position of the nail
and guide, in addition to the nail depth
imaging the 3.0 pins in the targeting
guide. Then refer to the steps listed
below to insert the guide pin(s) in the
oblique holes (Fig. 24).

Advance the spinning DRILL BIT through
the bone bicortically. Use fluoroscopy
to verify the appropriate location of the
DRILL BIT in the bone. The tip of the drill
should be no more than 5mm through
the far cortex of the bone to reduce the
risk of complications associated with
screw protrusion.
With the DRILL BIT in place and the DRILL
SLEEVE pressed against the bone, the
length of screw needed is indicated by
the etch marks on the DRILL BIT where
it exits the DRILL SLEEVE. (Alternatively,
the DRILL BIT and DRILL SLEEVE can be
removed and the SCREW DEPTH GAUGE
used to measure the length of screw.)
Alternatively, the cannulated technique,
as described below for the oblique
screws, can be used.
For Oblique Screws

Fig. 24

Fig. 22

CAUTION: Do not excessively impact
the SCREW CANNULA. Use appropriate
incision to seat the TROCAR/SCREW
CANNULA as impaction may cause loss
of accuracy (Fig. 23).

Returning to the transverse hole,
remove the GUIDE PIN and PIN SLEEVE,
and insert the appropriate sized DRILL
SLEEVE through the CANNULA down
to the bone. Place the appropriate
sized solid DRILL BIT through the DRILL
SLEEVE. Before the DRILL BIT contacts
the bone, start the drill. (Cannulated
technique is described below.)
It is suggested that the first screw be
placed in one of the transverse holes
prior to the oblique holes.

The cannulated technique must be used
for placement of the oblique screws.
Slide the TROCAR into the SCREW
CANNULA. Slide the SCREW CANNULA
through one of the selected holes in
the TARGETING MODULE. Incise the
skin at the point the TROCAR touches
it and dissect through the tissue down
to the bone to make a path for the
SCREW CANNULA. Advance the SCREW
CANNULA until the tip of the TROCAR is
against the bone.
Remove the TROCAR. Insert the 3.0mm
PIN SLEEVE through the CANNULA down
to the bone. Insert a 3.0mm PIN through
the bone (bicortical for transverse
screws, short of the far cortex for an
oblique screw). Remove the PIN SLEEVE.

Zimmer® Natural Nail® System - Retrograde Femoral Nail

Insert the CANNULATED DEPTH GAUGE
over the pin and observe the location
of the end of the pin in relation to
the etched calibration lines on the
CANNULATED DEPTH GAUGE to determine
length of screw. PLACE THE 4.9mm DRILL
SLEEVE in the CANNULA. Drill using the
4.9mm CANNULATED DRILL BIT through
the DRILL SLEEVE to the appropriate
depth, which is recommended to be at
least 10mm from the subchrondal bone
for bone that is less dense or severely
osteoporotic. It is recommended to use
a screw that would be at least 5mm from
the subchondral bone (Fig. 25).

Measure the appropriate screw length
using the marks on the calibrated drill
or the depth gauge (ensure the tip of the
shaft engages with the far cortex of the
bone). The SCREW CANNULA must be
seated on the bone for the calibration
lines to be accurate.
Remove the DRILL BIT and DRILL
SLEEVE. Place the appropriate length
and diameter screw through the SCREW
CANNULA into the bone. Use the 3.5mm
HEX SCREWDRIVER to advance the screw
to achieve good thread purchase, care
should be taken using fluoroscopy to
prevent perforating the subchondral
bone (the screw head should sit on the
near cortex of the bone). An etch line on
the SCREWDRIVER indicates when the
screw head is at the bone surface (this
is to be used as a reference and not the
primary check for the screw head being
seated on the bone). The screws are
self tapping so tapping should not be
necessary (Fig. 26).

CAUTION: When using any screwdriver
do not torque it beyond the calibration
line. Do not drive the screws into the
bone under power, as damage to the
bone, screws and nail could result. In
addition, avoid any excessive torque
or excessive force during final screw
seating.
Washers and Cortical Nuts

Fig. 26

Repeat this technique to place additional
distal screws as necessary.
Fig. 25

Washers can be used at any distal hole,
but CORTICAL NUTS may only be used
with the most distal TRANSVERSE SCREW.
(It is recommended to use the next
longest screw to ensure full engagement
with the cortical nut.) Follow the steps to
drill and measure for these screws. If a
washer and/or cortical nut will be used
add at least 3mm to the screw length.
Remove the DRILL SLEEVE after obtaining
appropriate screw length and insert the
3.0mm PIN SLEEVE. Place a 3.0mm PIN
through the PIN SLEEVE bicortically so
that it causes the medial skin to bulge.
Incise at the bulge and dissect down to
the bone. Attach the COUNTERBORE to
the T-HANDLE and advance through the
hole on the medial side of the guide.
Advance the COUNTERBORE over the
3.0mm PIN down to the bone.

Zimmer® Natural Nail® System - Retrograde Femoral Nail

Rotate the COUNTERBORE to remove
bone for the placement of the CORTICAL
NUT. The shoulder on the COUNTERBORE
should be advanced to the level of the
medial cortex (Fig. 27).

the guide over the screw until it seats
onto the cortex. Tighten the CORTICAL
NUT to the tip of the 6.0mm SCREW using
the CORTICAL NUT DRIVER. Use an image
intensifier to verify proper position.
CAUTION: Do not overtighten the nut.

Proximal Screw Placement –
Short Nails:

The TARGETING GUIDE is designed
to target the proximal static (ST) and
dynamic (DY) holes in SHORT nails.
Assemble the appropriate TARGETING
MODULE (16cm, 20cm, or 24cm
correspond to SHORT nail length) to the
TARGETING GUIDE laterally (Figs. 28 and
28a).

Use 5.0mm FIXED ANGLE SCREWS or
PARTIALLY THREADED SCREWS through
the appropriate proximal holes in the
nail.

Fig. 27

NOTE: The corresponding COUNTERBORE
and CORTICAL NUT DRIVER are marked
with the color code PURPLE
CAUTION: Do not counterbore or drive
the cortical nut into the bone under
power, as damage to the bone, screws
and nail could result. In addition, using
the depth gauge after counterboring
can lead to error in screw length
measurement.
Remove the COUNTERBORE, 3.0mm PIN
and PIN SLEEVE. The screw cannula
can be inserted to help facilitate screw
insertion, keep cannula outside of skin,
insert screw into cannula, advance screw
out of exit end of cannula, load washer,
then insert cannula back into wound site
before screw insertion. Before the screw
enters the wound, insert a washer onto
the screw. Then begin driving the screw
into the bone and through the hole in the
nail. Attach the CORTICAL NUT DRIVER to
the T-HANDLE. Put a CORTICAL NUT into
the CORTICAL NUT DRIVER and pass it
through the hole on the medial side of

There is no locking tab built in for short
nails proximally. Therefore either screw
type will result in a standard locking
construct.
Color coded instruments are also used
for proximal targeting of short nails. For
the RETROGRADE FEMUR TARGETING
GUIDE, instruments marked PURPLE are
utilized to place the proximal screws.
The chart below details the color coded
instruments that are used for proximal
targeting and screw placement.

Fig. 28

Instrument Type
8.0mm Screw Cannula

Purple

4.3mm Drill Bit

Purple–Red

4.3mm Drill Sleeve

Purple–Red

Screw Depth Gauge

Purple

Screwdriver

Purple

Screw Trocar

Purple

Fig. 28a

Zimmer® Natural Nail® System - Retrograde Femoral Nail

Slide the TROCAR into the SCREW
CANNULA. Slide the SCREW CANNULA
through one of the selected holes in
the TARGETING MODULE. Incise the
skin at the point the TROCAR touches
it and dissect through the tissue down
to the bone to make a path for the
SCREW CANNULA. Advance the SCREW
CANNULA until the tip of the TROCAR is
against the bone.
Remove the Screw Trocar and assemble
the 4.3mm DRILL SLEEVE to the 8.0mm
SCREW 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 (Fig. 29).

The nail utilizes a 5.0mm screw
proximally. The screw packages are
labeled with the color RED.
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.
CAUTION: When using any screwdriver,
do not torque it beyond the calibration
line. 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.

Proximal Screw Placement –
Freehand Technique for Long
Nails:

Insert the FREEHAND 4.3mm DRILL BIT
(RED) into the FREEHAND TARGETING
WAND. Finger tighten the SET SCREW.
Position the C-arm in order to get an
AP view of the proximal 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 centre of the hole.
Align the drill bit with the C-arm beam.
Tap the drill bit into the bone using the
MALLET (Fig. 30).

Fig.30

The chart below indicates the color
coding for proximal screws and their
associated drill bits for each nail
diameter.

Fig. 29

CAUTION: Do not impact on the cannula,
as the tip of the cannula may skive along
the bone and prevent accurate targeting.
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.

Nail Diameter

Screw Size

Drill Bit Size

Color Code

All diameters

5.0mm

4.3mm

Red

Remove the FREEHAND TARGETING
WAND. Slide the FREEHAND TISSUE
PROTECTION SLEEVE over the DRILL
BIT. Attach the DRILL to the FREEHAND
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 FREEHAND SCREW
DEPTH GAUGE. Choose a fixed angle
or partially threaded screw and insert
the appropriate length screw using the
screwdriver.

Zimmer® Natural Nail® System - Retrograde Femoral Nail

Finalize Implant Placement
Observe the depth of the nail in distal
femur. Ridges in the targeting guide
barrel indicate 5 and 10mm of depth.
Using the nail depth gauge technique
described earlier will also indicate the
nail depth.
Disconnect any TARGETING MODULES
from the TARGETING GUIDE and set
aside. Choose the appropriate height
cannulated NAIL CAP. If a NAIL CAP 5mm
or longer is chosen place a 2.0MM GUIDE
PIN through the CONNECTING BOLT down
to the level of the distal screws. Loosen
and remove the CONNECTING BOLT from
the nail. Remove the TARGETING GUIDE
HANDLE and set aside.

If a 0mm height NAIL CAP is used
insert using the CONNECTION BOLT
INSERTER. If a 5, 10 or 15mm height
cap is used, secure the selected NAIL
CAP to the NAIL CAP INSERTER using
the NAIL CAP RETAINING SHAFT. Ensure
an unobstructed pathway exists to the
distal end of nail to facilitate NAIL CAP
insertion. Slide the cannulated NAIL CAP
over the 2.0MM GUIDE PIN and tighten
to the nail. Using the C-arm, verify that
the cap is completely seated to 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.

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.
It is the responsibility of the surgeon
to determine what is the most suitable
postoperative care depending on each
patient’s health condition.

Nail Extraction
Use the C-arm to locate any proximal
screws. Remove the proximal screws
using a 3.5mm HEX SCREWDRIVER.
Remove the nail cap (if one was inserted)
with a 5.0mm HEX SCREWDRIVER.
Expose the distal screws, cortical nut and
washer, use a 3.5mm HEX SCREWDRIVER
and a RETROGRADE FEMUR CORTICAL
NUT DRIVER to remove them. If bone has
grown into any of the screws, nail cap,
nail, or cortical nut/washer that would
inhibit implant removal, use instruments
such as rongeurs, dental picks or
drills to remove bone in-growth before
attempting implant removal. Take care
not to damage the implant itself while
removing ingrown bone.
To remove the nail, slide a 2.0mm PIN
through the nail. Insert the 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.
Zimmer also offers a Universal Extraction
System should one be required.

Zimmer® Natural Nail® System - Retrograde Femoral Nail

Retrograde Femur Long Nail Details

Anterior bevel on tip

Dynamic Slot 10 to 25mm from tip
32 to 37mm from tip

1270mm
Anterior Bow Radius
Lengths 28 through 44cm

10, 11.5, 13mm Shaft Diameters
6.0mm Screw
8mm Diameter Head

Straight Flutes

3.4mm Head Height
4.8mm Minor Diameter
4.9mm Drill
2.8mm Tip Length
5.0mm Screw
8mm Diameter Head
3.9mm Head Height
4.3mm Minor Diameter
4.3mm Drill
2.1mm Tip Length

45 to 51mm from Head
37 to 44mm from Head (Oblique hole)

59mm distal body length

23 to 30mm from Head (Oblique hole)
9 to 15mm from Head
13mm Head

Zimmer® Natural Nail® System - Retrograde Femoral Nail

Retrograde Femur Short Nail Details

Anterior bevel on tip

11 to 16mm from tip
Dynamic Slot 22 to 37mm from tip
43 to 48mm from tip

1270mm
Anterior Bow Radius
Lengths 16 through 24cm

10, 11.5, 13mm Shaft Diameters

Straight Flutes
6.0mm Screw
8mm Diameter Head
3.4mm Head Height
4.8mm Minor Diameter
4.9mm Drill
2.8mm Tip Length
5.0mm Screw

45 to 51mm from head

59mm distal body length

8mm Diameter Head
3.9mm Head Height

37 to 44mm from head
(Oblique hole)

4.3mm Minor Diameter

23 to 30mm from head
(Oblique hole)

2.1mm Tip Length

4.3mm Drill

9 to 15mm from head
13mm Head

NOTE: There is no locking tab for
retrograde femur short nails proximally.

Zimmer® Natural Nail® System - Retrograde Femoral Nail

Product Information

47-2494-300-11

Retrograde Femur Nails

Retrograde Femoral Nail 11.5 mm X 30cm
Universal Ti-6Al-4V Alloy

47-2494-320-11

Retrograde Femoral Nail 11.5 mm X 32cm
Universal Ti-6Al-4V Alloy

47-2494-340-11

Retrograde Femoral Nail 11.5 mm X 34cm
Universal Ti-6Al-4V Alloy

Short Nails
Part Number

Description

47-2494-160-10

Retrograde Short Femoral Nail 10mm X
16cm Universal Ti-6Al-4V Alloy

47-2494-360-11

Retrograde Femoral Nail 11.5 mm X 36cm
Universal Ti-6Al-4V Alloy

47-2494-200-10

Retrograde Short Femoral Nail 10mm X
20cm Universal Ti-6Al-4V Alloy

47-2494-380-11

Retrograde Femoral Nail 11.5 mm X 38cm
Universal Ti-6Al-4V Alloy

47-2494-240-10

Retrograde Short Femoral Nail 10mm X
24cm Universal Ti-6Al-4V Alloy

47-2494-400-11

Retrograde Femoral Nail 11.5 mm X 40cm
Universal Ti-6Al-4V Alloy

47-2494-160-11

Retrograde Short Femoral Nail 11.5mm X
16cm Universal Ti-6Al-4V Alloy

47-2494-420-11

Retrograde Femoral Nail 11.5 mm X 42cm
Universal Ti-6Al-4V Alloy

47-2494-200-11

Retrograde Short Femoral Nail 11.5 mm X
20cm Universal Ti-6Al-4V Alloy

47-2494-440-11

Retrograde Femoral Nail 11.5 mm X 44cm
Universal Ti-6Al-4V Alloy

47-2494-240-11

Retrograde Short Femoral Nail 11.5 mm X
24cm Universal Ti-6Al-4V Alloy

47-2494-280-13

Retrograde Femoral Nail 13mm X 28cm
Universal Ti-6Al-4V Alloy

47-2494-160-13

Retrograde Short Femoral Nail 13mm X
16cm Universal Ti-6Al-4V Alloy

47-2494-300-13

Retrograde Femoral Nail 13mm X 30cm
Universal Ti-6Al-4V Alloy

47-2494-200-13

Retrograde Short Femoral Nail 13mm X
20cm Universal Ti-6Al-4V Alloy

47-2494-320-13

Retrograde Femoral Nail 13mm X 32cm
Universal Ti-6Al-4V Alloy

47-2494-240-13

Retrograde Short Femoral Nail 13mm X
24cm Universal Ti-6Al-4V Alloy

47-2494-340-13

Retrograde Femoral Nail 13mm X 34cm
Universal Ti-6Al-4V Alloy

47-2494-360-13

Retrograde Femoral Nail 13mm X 36cm
Universal Ti-6Al-4V Alloy

47-2494-380-13

Retrograde Femoral Nail 13mm X 38cm
Universal Ti-6Al-4V Alloy

47-2494-400-13

Retrograde Femoral Nail 13mm X 40cm
Universal Ti-6Al-4V Alloy

Long Nails
Part Number

Description

47-2494-280-10

Retrograde Femoral Nail 10mm X 28cm
Universal Ti-6Al-4V Alloy

47-2494-420-13

Retrograde Femoral Nail 13mm X 42cm
Universal Ti-6Al-4V Alloy

47-2494-300-10

Retrograde Femoral Nail 10mm X 30cm
Universal Ti-6Al-4V Alloy

47-2494-440-13

Retrograde Femoral Nail 13mm X 44cm
Universal Ti-6Al-4V Alloy

47-2494-320-10

Retrograde Femoral Nail 10mm X 32cm
Universal Ti-6Al-4V Alloy

47-2494-340-10

Retrograde Femoral Nail 10mm X 34cm
Universal Ti-6Al-4V Alloy

47-2494-360-10

6.0mm Screws (for distal screw holes)
Part Number

Description

Retrograde Femoral Nail 10mm X 36cm
Universal Ti-6Al-4V Alloy

47-2484-030-60

6.0mm Cancellous Screw 30mm Length
Ti-6Al-4V Fixed Angle 3.5mm Hex Head

47-2494-380-10

Retrograde Femoral Nail 10mm X 38cm
Universal Ti-6Al-4V Alloy

47-2484-035-60

6.0mm Cancellous Screw 35mm Length
Ti-6Al-4V Fixed Angle 3.5mm Hex Head

47-2494-400-10

Retrograde Femoral Nail 10mm X 40cm
Universal Ti-6Al-4V Alloy

47-2484-040-60

6.0mm Cancellous Screw 40mm Length
Ti-6Al-4V Fixed Angle 3.5mm Hex Head

47-2494-420-10

Retrograde Femoral Nail 10mm X 42cm
Universal Ti-6Al-4V Alloy

47-2484-045-60

6.0mm Cancellous Screw 45mm Length
Ti-6Al-4V Fixed Angle 3.5mm Hex Head

47-2494-440-10

Retrograde Femoral Nail 10mm X 44cm
Universal Ti-6Al-4V Alloy

47-2484-050-60

6.0mm Cancellous Screw 50mm Length
Ti-6Al-4V Fixed Angle 3.5mm Hex Head

47-2494-280-11

Retrograde Femoral Nail 11.5 mm X 28cm
Universal Ti-6Al-4V Alloy

47-2484-055-60

6.0mm Cancellous Screw 55mm Length
Ti-6Al-4V Fixed Angle 3.5mm Hex Head

Zimmer® Natural Nail® System - Retrograde Femoral Nail

47-2484-060-60

6.0mm Cancellous Screw 60mm Length
Ti-6Al-4V Fixed Angle 3.5mm Hex Head

47-2483-047-50

5.0mm Cortical Screw 47.5mm Length Ti6Al-4V Partially Threaded 3.5mm Hex Head

47-2484-065-60

6.0mm Cancellous Screw 65mm Length
Ti-6Al-4V Fixed Angle 3.5mm Hex Head

47-2483-050-50

5.0mm Cortical Screw 50mm Length Ti-6Al4V Partially Threaded 3.5mm Hex Head

47-2484-070-60

6.0mm Cancellous Screw 70mm Length
Ti-6Al-4V Fixed Angle 3.5mm Hex Head

47-2483-052-50

5.0mm Cortical Screw 52.5mm Length Ti6Al-4V Partially Threaded 3.5mm Hex Head

47-2484-075-60

6.0mm Cancellous Screw 75mm Length
Ti-6Al-4V Fixed Angle 3.5mm Hex Head

47-2483-055-50

5.0mm Cortical Screw 55mm Length Ti-6Al4V Partially Threaded 3.5mm Hex Head

47-2484-080-60

6.0mm Cancellous Screw 80mm Length
Ti-6Al-4V Fixed Angle 3.5mm Hex Head

47-2483-057-50

5.0mm Cortical Screw 57.5mm Length Ti6Al-4V Partially Threaded 3.5mm Hex Head

47-2484-085-60

6.0mm Cancellous Screw 85mm Length
Ti-6Al-4V Fixed Angle 3.5mm Hex Head

47-2483-060-50

5.0mm Cortical Screw 60mm Length Ti-6Al4V Partially Threaded 3.5mm Hex Head

47-2484-090-60

6.0mm Cancellous Screw 90mm Length
Ti-6Al-4V Fixed Angle 3.5mm Hex Head

47-2484-095-60

6.0mm Cancellous Screw 95mm Length
Ti-6Al-4V Fixed Angle 3.5mm Hex Head

47-2484-020-50

5.0mm Cortical Screw 20mm Length Ti-6Al4V Fixed Angle 3.5mm Hex Head

47-2484-100-60

6.0mm Cancellous Screw 100mm Length
Ti-6Al-4V Fixed Angle 3.5mm Hex Head

47-2484-022-50

5.0mm Cortical Screw 22.5mm Length Ti6Al-4V Fixed Angle 3.5mm Hex Head

47-2484-105-60

6.0mm Cancellous Screw 105mm Length
Ti-6Al-4V Fixed Angle 3.5mm Hex Head

47-2484-025-50

5.0mm Cortical Screw 25mm Length Ti-6Al4V Fixed Angle 3.5mm Hex Head

47-2484-110-60

6.0mm Cancellous Screw 110mm Length
Ti-6Al-4V Fixed Angle 3.5mm Hex Head

47-2484-027-50

5.0mm Cortical Screw 27.5mm Length Ti6Al-4V Fixed Angle 3.5mm Hex Head

47-2484-030-50

5.0mm Cortical Screw 30mm Length Ti-6Al4V Fixed Angle 3.5mm Hex Head

5.0mm Screws (for proximal screw holes)

47-2484-032-50

5.0mm Cortical Screw 32.5mm Length Ti6Al-4V Fixed Angle 3.5mm Hex Head

Part Number

Description

47-2484-035-50

47-2483-020-50

5.0mm Cortical Screw 20mm Length Ti-6Al4V Partially Threaded 3.5mm Hex Head

5.0mm Cortical Screw 35mm Length Ti-6Al4V Fixed Angle 3.5mm Hex Head

47-2484-037-50

47-2483-022-50

5.0mm Cortical Screw 22.5mm Length Ti6Al-4V Partially Threaded 3.5mm Hex Head

5.0mm Cortical Screw 37.5mm Length Ti6Al-4V Fixed Angle 3.5mm Hex Head

47-2484-040-50

47-2483-025-50

5.0mm Cortical Screw 25mm Length Ti-6Al4V Partially Threaded 3.5mm Hex Head

5.0mm Cortical Screw 40mm Length Ti-6Al4V Fixed Angle 3.5mm Hex Head

47-2484-042-50

47-2483-027-50

5.0mm Cortical Screw 27.5mm Length Ti6Al-4V Partially Threaded 3.5mm Hex Head

5.0mm Cortical Screw 42.5mm Length Ti6Al-4V Fixed Angle 3.5mm Hex Head

47-2484-045-50

47-2483-030-50

5.0mm Cortical Screw 30mm Length Ti-6Al4V Partially Threaded 3.5mm Hex Head

5.0mm Cortical Screw 45mm Length Ti-6Al4V Fixed Angle 3.5mm Hex Head

47-2484-047-50

47-2483-032-50

5.0mm Cortical Screw 32.5mm Length Ti6Al-4V Partially Threaded 3.5mm Hex Head

5.0mm Cortical Screw 47.5mm Length Ti6Al-4V Fixed Angle 3.5mm Hex Head

47-2484-050-50

47-2483-035-50

5.0mm Cortical Screw 35mm Length Ti-6Al4V Partially Threaded 3.5mm Hex Head

5.0mm Cortical Screw 50mm Length Ti-6Al4V Fixed Angle 3.5mm Hex Head

47-2484-052-50

47-2483-037-50

5.0mm Cortical Screw 37.5mm Length Ti6Al-4V Partially Threaded 3.5mm Hex Head

5.0mm Cortical Screw 52.5mm Length Ti6Al-4V Fixed Angle 3.5mm Hex Head

47-2484-055-50

47-2483-040-50

5.0mm Cortical Screw 40mm Length Ti-6Al4V Partially Threaded 3.5mm Hex Head

5.0mm Cortical Screw 55mm Length Ti-6Al4V Fixed Angle 3.5mm Hex Head

47-2484-057-50

47-2483-042-50

5.0mm Cortical Screw 42.5mm Length Ti6Al-4V Partially Threaded 3.5mm Hex Head

5.0mm Cortical Screw 57.5mm Length Ti6Al-4V Fixed Angle 3.5mm Hex Head

47-2484-060-50

47-2483-045-50

5.0mm Cortical Screw 45mm Length Ti-6Al4V Partially Threaded 3.5mm Hex Head

5.0mm Cortical Screw 60mm Length Ti-6Al4V Fixed Angle 3.5mm Hex Head

Zimmer® Natural Nail® System - Retrograde Femoral Nail

Nail Caps

00-2490-004-24

RETROGRADE FEMUR TARGETING
MODULE 24CM

00-2490-010-01

SHORT CANNULATED AWL

00-2490-012-00

GUIDE WIRE GRIPPER

00-2490-013-14

Retrograde Femoral Nail Cap 10mm Height
Ti-6Al-4V

RETROGRADE FEMUR TAPER REAMER
13.5MM

00-2490-014-80

ENTRY REAMER 8MM

Retrograde Femoral Nail Cap 15mm Height
Ti-6Al-4V

00-2490-017-00

GUIDE WIRE PUSHER

00-2490-031-00

CONNECTING BOLT INSERTER

00-2490-032-02

RETROGRADE FEMUR IMPACTION
HEAD

00-2490-032-05

SLOTTED MALLET

00-2490-035-75

FREEHAND MODULAR 3.5MM HEX
SCREWDRIVER

00-2490-046-32

GUIDE PIN INSERTER/EXTRACTOR

00-2490-049-00

RETROGRADE FEMUR NUT
COUNTERBORE

00-2490-050-02

MODULAR T-HANDLE - HALL
CONNECTION

00-2490-065-85

RETROGRADE FEMUR SCREW DEPTH
GAUGE 8.0MM

00-2490-070-00

FREEHAND TARGETING WAND

00-2490-073-00

FREEHAND TARGETING DEPTH GAUGE

00-2490-074-00

FREEHAND TISSUE PROTECTION
SLEEVE

00-2490-080-00

NAIL CAP INSERTER

00-2237-008-00

SKIN PROTECTOR

02.00020.049

RATCHET WRENCH 11

00-2490-090-25

RETROGRADE FEMUR CANNULATED
EXTRACT ADAPTER 5/16 INCH

00-2490-035-80

RETROGRADE FEMUR MODULAR
SCREWDRIVER 3.5MM HEX

00-2490-050-00

MODULAR T-HANDLE AO
CONNECTION

00-2490-065-43

RETROGRADE FEMUR DRILL SLEEVE
4.3MM

Part Number

Description

47-2487-008-00

Retrograde Femoral Nail Cap 0mm Height
Ti-6Al-4V

47-2487-008-05

Retrograde Femoral Nail Cap 5mm Height
Ti-6Al-4V

47-2487-008-10
47-2487-008-15

Cortical Nuts and Washers
Part Number

Description

47-2488-000-01

Cortical Nut Ti-6Al-4V for the 6.0mm
Cancellous Screw (Sterile)

47-2488-000-02

Washer Ti-6Al-4V (sterile)

Non sterile Screws and Washers are also available.
Please contact your Sales Representative.

KT-2490-004-00 Retrograde Femoral
Instrument Set
Part Number

Description

Qty.

00-2490-004-02

RETROGRADE FEMUR CONNECTING
BOLT

00-2490-031-05

11MM HEX / PIN WRENCH

00-2490-046-20

2.0MM PIN

00-2490-071-80

RETROGRADE FEMUR SCREW
CANNULA 8.0MM

00-2490-072-80

RETROGRADE FEMUR TROCAR 8.0MM

00-2490-073-80

RETROGRADE FEMUR TRI-FLUTE
TROCAR 8.0MM

00-2490-063-40

RETROGRADE FEMUR GUIDE PIN
SLEEVE 3.0MM

00-2490-000-33

RULER

00-2490-000-34

NAIL LENGTH GAUGE

00-2490-004-00

RETROGRADE FEMUR TARGETING
GUIDE

00-2490-065-49

RETROGRADE FEMUR DRILL SLEEVE
4.9MM

00-2490-004-16

RETROGRADE FEMUR TARGETING
MODULE 16CM

00-2490-034-43

RETROGRADE FEMUR CALIBRATED
DRILL 4.3MM

00-2490-004-20

RETROGRADE FEMUR TARGETING
MODULE 20CM

00-2490-034-49

RETROGRADE FEMUR CALIBRATED
DRILL 4.9MM

Zimmer® Natural Nail® System - Retrograde Femoral Nail

00-2490-034-50

RETROGRADE FEMUR CALIBRATED
DRILL 4.9MM CANNULATED

00-2490-072-43

FREEHAND TARGETING DRILL 4.3MM

00-2490-047-30

3.0MM NON-THREADED PIN BY
355MM

00-2490-024-00

REDUCTION FINGER

00-2490-004-22

RETROGRADE FEMUR NAIL DEPTH
GAUGE

00-2490-047-81

RETROGRADE FEMUR CANNULATED
DEPTH GAUGE

00-4452-092-25

PROTECTIVE CAP (2.5-3.0MM)

00-2490-035-90

RETROGRADE FEMUR CORTICAL NUT
DRIVER

00-2490-013-00

Optional Instruments
Part Number

Description

00-2490-048-50

LONG 5.0MM TAP

00-2255-009-00

SLAPHAMMER

00-0409-003-00

IM NAIL EXTRACTION SET #2

00-0409-004-00

IM NAIL EXTRACTION PIN WIRE SET

00-0409-006-00

IM NAIL EXTRACTION COMPLETE SET

00-2490-014-30

3.0MM THREADED PIN BY 355MM

00-2490-004-30

RETRORADE FEMORAL MODULAR TARGET
GUIDE

ENTRY CANNULA

00-2490-004-31

RETROGRADE FEMORAL MODULAR TARGET
GUIDE MODULE LEFT

00-2490-013-01

ENTRY CANNULA STARTING POINT
LOCATER

00-2490-004-32

RETROGRADE FEMORAL MODULAR TARGET
GUIDE MODULE RIGHT

00-2490-080-03

NAIL CAP RETAINING SHAFT

00-2490-035-62

CAPTURING HEX SCREWDRIVER
3.5MM SHORT

00-2490-035-72

CAPTURING HEX SCREWDRIVER
3.5MM FREEHAND

00-5900-099-00

CASE LID

Tear Drop Guide Wire (available separately)
Part Number

Description

47-2490-097-00

3.0mm x 100 cm Tear Drop Guide Wire
sterile

47-2490-097-01

Instruments (Select both “Stainless Steel” or both
“Stainless Steel and Aluminum” Cases

2.4mm x 100 cm Tear Drop Guide Wire
sterile

47-2490-098-00

3.0mm x 70 cm Tear Drop Guide Wire
sterile

Part Number

Description

47-2490-098-01

2.4mm x 70 cm Tear Drop Guide Wire
sterile

00-2490-011-00

Retrograde Femur Case 1 of 2 – Stainless
Steel

00-2490-023-00

Retrograde Femur Case 2 of 2 – Stainless
Steel

Part Number

Description

00-2490-070 -50

Retrograde Femur Case 1 of 2 – Stainless
Steel and Aluminum

00-2255-008-00

Guide Wire 2.4mm, Ball-Tip, 70cm box

00-2490-073-50

Retrograde Femur Case 2 of 2 – Stainless
Steel and Aluminum

47-2255-008-01

Guide Wire 3.0mm, Ball-Tip, 100cm Sterile

00-2255-008-01

Guide Wire 3.0mm, Ball-Tip, 100cm non
sterile

Ball Tip Guide Wire (available separately)

Surgical Technique Part Number -

97-2494-002-00

Wall Chart Part Number -

97-2494-003-00

Zimmer® Natural Nail® System - Retrograde Femoral Nail

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.

Contact your Zimmer representative or visit us at www.zimmer.com
The CE mark is valid only if it is also printed on the product label.

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Date Released                   : 7-7-2015
I D                             : 97-2494-002-00 Rev. 3  MC124250
Keywords                        : Zimmer® Natural Nail® System - Retrograde Femoral Nail, Preoperative Planning, Patient Positioning, Reduction, Starting Point Location, Distal Reaming, Shaft Reaming, Implant Selection, Nail Assembly and Insertion, Distal Screw Placement, Proximal Screw Placement: Short Nails, Proximal Screw Placement: Freehand Technique for Long Nails, Final Implant Placement, Postoperative Care, Nail Extraction, Retrograde Femur Long Nail Details, Retrograde Femur Short Nail Details, Product Information
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Title                           : Zimmer® Natural Nail® System - Retrograde Femoral Nail
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Creator                         : Zimmer, Inc.
Subject                         : Zimmer® Natural Nail® System - Retrograde Femoral Nail, Preoperative Planning, Patient Positioning, Reduction, Starting Point Location, Distal Reaming, Shaft Reaming, Implant Selection, Nail Assembly and Insertion, Distal Screw Placement, Proximal Screw Placement: Short Nails, Proximal Screw Placement: Freehand Technique for Long Nails, Final Implant Placement, Postoperative Care, Nail Extraction, Retrograde Femur Long Nail Details, Retrograde Femur Short Nail Details, Product Information
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Zimmer® Natural Nail® System Retrograde Femoral Nail Zimmer Surgical Technique

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