Zimmer ®

Natural Nail ®

System
Tibial Nail Surgical
Suprapatella Technique
Zimmer® Natural Nail® System - Tibial (Suprapatella) 1

Zimmer Natural Nail Table of Contents

System Tibial Nail
Surgical Technique Product Overview 2
(Suprapatella)
Implant Overview 2
Indications 2
Contraindications 2
Surgical Technique 3
Preoperative Planning 3
Patient Positioning 3
Reduction 3
Starting Point Location 3
Reaming 6
Nail Assembly and Insertion 6
Proximal Screw Placement 9
Distal Targeting – Freehand Technique 11
Finalize Implant Placement 13
Postoperative Care 13
Nail Extraction 13

Tibial Nail Details 14

Case Examples 15
Product Information 16
2 Zimmer® Natural Nail® System - Tibial (Suprapatella)

Product Overview Precision instrumentation is provided Contraindications

to help implant the nail. Many of the
The Zimmer Natural Nail System is a instruments and implants feature • A medullary canal obliterated by a
system of intramedullary nails, screws, color coding to help the surgical team previous fracture or tumor
instruments and other associated use the system, easily and efficiently.
Certain universal instruments are not • Bone shaft having excessive bow or
implants that are designed to provide
color coded. The color coding system is deformity
stable internal fixation for fractured long
bones. The nails have been designed referenced in the technique. A wall chart • Lack of bone substance or bone
for specific applications to help restore (97-2495-003-00) is also available to quality which makes stable seating of
the shape of the fractured bone to its help explain the color coding system. the implant impossible
natural, pre-injured state. The technique is written to explain use • All concomitant diseases that can
The Tibial Nail is designed to help treat of the SUPRAPATELLA TARGETING GUIDE impair the functioning and the
various fractures of the tibia. Screws are which should be used when the knee is success of the implant
placed through the nail to secure the in extension.
• Infection
implant in place and maintain length and
alignment while healing occurs. The nail Indications • Insufficient blood circulation
has multiple screw holes in the proximal
The Zimmer Natural Nail System is • Skeletally immature patients
body to allow surgeons to address
intended for temporary fracture fixation
different fracture types. The proximal slot
and stabilization of the bone. WARNING: This nail should only be
allows for compression or dynamization
used to treat a periprosthetic fracture
across a fracture. Indications for the tibial nails include the
if the in situ device is firmly fixed and
following:
A choice of lengths and diameters if the Suprapatella surgical approach is
is available to match the individual • Compound and simple shaft fractures not being used for implantation. When
anatomy of the patient. treating a periprosthetic fracture, the
• Proximal, metaphyseal and distal shaft
nail should be positioned so that it does
fractures
Implant Overview not come in contact with the in situ
• Segmental fractures device.
Nail Diameters: 8.3, 9.3, 10, 11, 12mm • Comminuted fractures
Nail Lengths: 24 to 44cm in 2cm • Fractures involving osteopenic and
increments osteoporotic bone
Proximal Screw Diameter: 5.0mm • Pathological fractures
Proximal Screw Lengths: 20 to 60mm • Fractures with bone loss
in 2.5mm increments, 65 to 100mm in
5mm increments • Periprosthetic fractures

Distal Screw Diameter: 4.0mm for 8.3mm • Pseudoarthrosis, non-union, mal-

diameter nails union and delayed union

5.0mm for 9.3mm and larger diameter • Surgically created defects such as
nails osteotomies

Distal Screw Lengths: 20 to 60mm in When this device is implanted using a

2.5mm increments, 65 to 100mm in Suprapatella surgical approach, all of
5mm increments the above indications apply with the
exception of Periprosthetic Fractures.
Materials: Ti-6Al-4V alloy
 Zimmer® Natural Nail® System - Tibial (Suprapatella) 3

Surgical Technique Starting Point Location

The starting point for the nail is located
Preoperative Planning on the shelf of the tibia, just medial to the
Preoperative planning is recommended Lateral Intracondylar Eminence (Fig. 1).
before beginning the surgical procedure. Avoid an excessively medial start point
A/P and Lateral x-rays of the injured tibia to minimize potential for intra-articular
should be taken preoperatively and damage. With the knee in full extension,
evaluated for length, canal size and make a 2cm longitudinal skin incision
implant suitability. A/P and Lateral x-rays either starting at the pole of the patella
of the contralateral uninjured tibia can or starting 1cm superior (corresponds
also be taken preoperatively to provide to one finger breadth) to the pole of the
insight into the characteristics of the pre- patella.
injured tibia.

Patient Positioning  
 
The patient should be positioned in the  
 
supine position. The positioning should  
 
allow the knee of the injured leg to be  
 
placed in at least 10°-20° of flexion. Use  
 
e.g. blankets, custom foam devices or  
 
sterile bumps to support this position.  
 
 
The use of a fracture table can be beneficial  
 
to help reduce fractures as well as to  
facilitate intraoperative imaging with a  
 
C-arm. The C-arm should be placed to allow  
 
for imaging of the tibia in both planes  
 
along the entire length of the bone.  

Drape the patient appropriately to allow the

surgeon to work from the knee to the foot.

Reduction
It is critical to achieve anatomic
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,
ball spike pushers and Steinman pins,
femoral distractors or external fixation Fig. 1
systems.
4 Zimmer® Natural Nail® System - Tibial (Suprapatella)

The deep incision, also longitudinal, CAUTION: Do not use ENTRY CANNULA
splits the quadriceps tendon in its without trocar properly assembled
midsubstance, just above its insertion or directly with the STARTING POINT
into the patella and enters the knee joint MODIFIER attached.
through the suprapatellar pouch.
Insert the handle assembly through the
incision into the knee joint so that it
glides between the articular surface of
the patella and the trochlea of the distal
femur and rests securely in this groove,
while the patella is displaced anteriorly.
When the CANNULATED TROCAR reaches
the surface of the tibia stop pushing
Fig. 2 down the handle assembly.
NOTE: The knee must remain in Fig. 5
extension or slightly flexed once the made by replacing the CANNULATED
handle assembly has been inserted. TROCAR by the STARTING POINT
MODIFIER (Fig. 5). Rotate it to place a
Pin Insertion second PIN while the first PIN remains
Blunt dissection can be used to loosen Place the 3.0mm PIN through the in place. Distance between the two
the patella in the suprapatellar pouch, CANNULATED TROCAR and advance to pins is 4mm. After correct placement
allowing the patella to lift off. Displace the anterior surface of the tibia (Fig. 4). of the second PIN the initial PIN and
the patella anteriorly. Slight adjustment of the knee flexion the STARTING POINT MODIFIER can be
(between 10°-20°) will provide the ideal removed.
Assemble the ENTRY CANNULA with the
corresponding blue ENTRY CANNULA radiographic location for the starting Once the ENTRY CANNULA is in place
HANDLE (Fig. 2). Orient the laser mark point and insertion of the PIN into the and the PIN position is verified, the
on the handle to any laser mark on the tibia. CANNULATED TROCAR can be removed
cannula. from the surgical field (Fig. 6). If needed,
a standard suction device can be
attached to the ENTRY CANNULA.
Fig. 4
Place the 8mm ENTRY REAMER over
the PIN, through the ENTRY CANNULA
and down to the bone (Fig. 7). Using
fluoroscopy, ream an entry portal into
the proximal tibia to the metadiaphyseal
flare. The PIN and the ENTRY REAMER
Fig. 3 should not reach the posterior cortex.

Insert the CANNULATED TROCAR into the

handle assembly. Push down on and lock
the inner instruments to make sure that Use the C-arm to visualize the pin’s
everything is properly put together (Fig. 3). position from A/P and Lateral views. The
PIN should be inserted at the identified Fig. 6
NOTE: Inspect the ENTRY CANNULA as it point heading slightly posterior into the
may become damaged, bend or chipped medullary canal.
with excessive prior reaming and
insertion of any other instruments. Any Drive the pin through the starting point
flaws in the tube can lead to damage of into the center of the medullary canal.
the surrounding tendons and tissues. Adjustments to the PIN location can be
 Zimmer® Natural Nail® System - Tibial (Suprapatella) 5

the proximal tibia by 0.5 to 1.0mm to Assemble the two piece NAIL LENGTH
accommodate the proximal portion of GAUGE. Slide the tube portion of the
the nail. The groove in the reamer flutes gauge over the 3.0mm x 100cm GUIDE
indicates the final position of the top of WIRE until the tip of the tube is at the
the nail. In addition, the c-arm should level of the entry point (confirm position
be used to visualize the depth of the
using fluoroscopy)( Fig. 10).
reamer in the proximal tibia. Care should
be taken to keep the reamer in line with
the shaft of the tibia to avoid reaming
through the cortex of the tibia.
Remove the pin.
Place a 3.0mm x 100cm BALL TIP GUIDE
Fig. 10
Fig. 7
WIRE or TEAR DROP GUIDE WIRE through
the ENTRY CANNULA into the medullary
canal all the way into the distal tibia. To
aid in manipulation, bend the tip of the
Remove the ENTRY REAMER. GUIDE WIRE at about a 100 angle 5cm
from the end.
Alternatively, a STRAIGHT AWL or a 12mm The proximal end of the GUIDE WIRE
ENTRY REAMER can be used to find the CAUTION: If the GUIDE WIRE is bent indicates the length of the wire in the
entry point and create the entry portal (Fig. 8). shorter than 5cm from the end of the canal (Fig. 11). When determining nail
wire and/or more than 10 degrees it may length, consideration should be taken as
NOTE: Do not use the STRAIGHT AWL
be difficult to remove from the nail. If to how deep the nail will be inserted into
with power. Always attach the MODULAR
the wire becomes lodged inside the nail, the tibia based upon the desired location
HANDLE to perform the opening of the
utilize the GUIDE WIRE GRIPPER and
IM canal. of the proximal screws. A RULER is also
mallet to remove the guide wire from the
included in the set which can be used to
nail.
radiographically determine nail length.
Fluoroscopy can assist you in guiding
the GUIDE WIRE past the fracture site. If
you plan to ream the canal of the tibia,
the GUIDE WIRE should be centered and
embedded in the distal tibia at the level
of the distal epiphyseal scar using the
GUIDE WIRE GRIPPER and a MALLET (Fig.
9). Care should be taken not to drive the
wire through the ankle joint.
Fig. 11
Fig. 8

Fig. 9
If a 70cm GUIDE WIRE is used, measure
Only nails up to 12mm may be used
with this technique. If an 8mm entry the length of the canal by sliding only the
reamer was used for proximal reaming, half of the NAIL LENGTH GAUGE that is
then use the 12.0mm ENTRY REAMER to etched with length measurements to the
finish preparing the proximal tibia for level of the entry point. The proximal end
the proximal portion of the nail (sizes of the 70cm GUIDE WIRE will indicate the
8-11mm). If the bone is especially length of the wire that is in the canal.
dense, it may be necessary to over-ream
6 Zimmer® Natural Nail® System - Tibial (Suprapatella)

Reaming NOTE: The ENTRY CANNULA allows

Attach a standard suction device to the reamers up to 13.5mm to go through.
ENTRY CANNULA to remove reaming Do not use a larger reamer. Therefore
debris from the knee joint. nails with a diameter of 13mm or 14mm
can’t be utilized with the suprapatella
Insert the reamer over the GUIDE WIRE instrumentation.
through the ENTRY CANNULA. Start with
a small reamer. Increase the diameter of NOTE: If the GUIDE WIRE becomes
the reamer by 0.5 - 1.0mm depending lodged within the reamer, use the GUIDE
on the amount of resistance felt while WIRE PUSHER to push the GUIDE WIRE
reaming. back into the IM canal.

NOTE: If the reamer head gets stuck in

the IM canal or interferes with the ENTRY Nail Assembly and Insertion
CANNULA, tilt the ENTRY CANNULA The color code for the tibial nail is
HANDLE to a anterior-inferior position YELLOW. Ti-6Al-4V alloy nails, the
to re-align the reamer head and ENTRY SUPRAPATELLAR TARGETING GUIDE and
CANNULA (Fig. 12). the CONNECTING BOLT all have yellow
colors and the word YELLOW etched on
The GUIDE WIRE PUSHER can help them. Place the appropriate CONNECTING
prevent the GUIDE WIRE from coming out BOLT (Suprapatella) through the barrel
of the tibia during reaming. When cortical of the LONG TARGETING GUIDE HANDLE.
chatter occurs, stop reaming. Choose a Begin threading the CONNECTING BOLT
nail that is 1.0 – 1.5mm smaller than the (by hand or using the CONNECTING BOLT
last reamer used. The proximal diameter INSERTER) into the proximal portion of
of nails equal to or smaller than 11mm the nail. Orient the nail so that the distal
in diameter is 11mm. For nails 11mm portion of the nail angles anterior, the
and larger in diameter, the diameter of same direction as the TARGETING GUIDE
the nail is constant. If a nail smaller than HANDLE (Fig. 13).
11mm is to be used, be sure to ream the
proximal portion of the bone to 11.5mm
to accommodate the proximal portion of
the nail.

Fig. 13

Fig. 12
 Zimmer® Natural Nail® System - Tibial (Suprapatella) 7

Slots in the top of the nail will match

tabs on the TARGETING GUIDE HANDLE to
help orient the nail correctly. Completely
tighten the CONNECTING BOLT to secure
the nail to the guide (Fig. 14). The arrow
on the nail will line up with the arrow on
the barrel of the guide when the nail is
correctly aligned.

Fig. 14

Attach the TARGETING MODULE to the

TARGETING GUIDE HANDLE. Use a screw
cannula, drill sleeve and drill bit to verify
that the holes in the guide target the
holes in the nail. Remove the TARGETING
MODULE BEFORE inserting the nail.

Insert the NAIL over the GUIDE WIRE with

the arm of the guide facing anterior.
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 (Fig. 15).

NOTE: Before inserting the nail, the

ENTRY CANNULA has to be removed as
the nail will not pass through it.
Fig. 15
8 Zimmer® Natural Nail® System - Tibial (Suprapatella)

If the nail does not pass down the canal

easily, attach the IMPACTION HEAD to
the TARGETING GUIDE HANDLE. Using the
MALLET, impact gently on the IMPACTION
HEAD (Fig. 16). Do not impact when the
MODULE is attached to the IMPACTION
HEAD. Verify that the CONNECTING BOLT
is tight while impacting. Do not impact
on any other portion of the TARGETING
GUIDE HANDLE or MODULE 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. Place the top of
the nail in line with or below the surface Fig. 16
of the tibia, depending on its position
relative to the expected screw location.
Care should be taken to not pry on the
handle as this may cause damage to the
instrumentation.

Remove the GUIDE WIRE from the nail

using the GUIDE WIRE GRIPPER (Fig. 17).
If possible, remove the GUIDE WIRE
before fully seating the nail, if desired.

Fig. 17
 Zimmer® Natural Nail® System - Tibial (Suprapatella) 9

Proximal Screw Placement Retighten the CONNECTING BOLT to Slide the TROCAR into the SCREW
the nail. CANNULA. Slide the SCREW CANNULA
All of the screw holes in the tibial nail
through one of the selected holes in the
allow for standard locking or fixed angle Attach the TARGETING MODULE to the
TARGETING MODULE. Dissect through
locking. To achieve standard locking, TARGETING GUIDE HANDLE (Fig. 18).
the tissue down to the bone to make a
choose a PARTIALLY THREADED SCREW. Select the screw holes that will be used
path for the SCREW CANNULA (Fig. 19).
To achieve a fixed angle construct, in the nail. Insert HOLE INDICATORS in
Advance the SCREW CANNULA until the
choose a FIXED ANGLE SCREW. the holes in the TARGETING MODULE that
tip of the TROCAR is against the bone
will NOT be used.
Instruments that are specific to the (Fig. 20).
tibia nail are marked in YELLOW. The
instruments needed to place screws
through the proximal portion of the nail
are color coded ORANGE/ORANGE. These
instruments are placed through holes in
the targeting guide which are color coded
ORANGE. The chart below details the
color coded instruments that are used to
target and place screws.
Fig. 19
INSTRUMENT TYPE COLOR CODE
Screw Cannula Orange/Orange
Trocar Orange/Orange
4.3mm Drill Sleeve Orange/Orange & Red
4.3mm Drill Bit Orange/Orange & Red
Depth Gauge Orange
Screwdriver Orange/Orange

Fig. 18

Fig. 20

*Under certain conditions, especially in patients with thin cortical bone,

Partially Threaded Screws from 20mm to 32.5mm in length may form a
Fixed Angle construct with the nail.
10 Zimmer® Natural Nail® System - Tibial (Suprapatella)

Remove the TROCAR. Insert the 4.3mm Repeat this technique to place
DRILL SLEEVE through the CANNULA additional proximal screws as necessary.
down to the bone. Place the 4.3mm
DRILL BIT through the DRILL SLEEVE.
Before the DRILL BIT contacts the bone,
start the drill. Advance the spinning
DRILL BIT through the bone bicortically.
Use fluoroscopy to verify the appropriate
Fig. 21
location of the DRILL BIT in the bone.

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 SCREW CANNULA (Fig. 21).
The tip of the drill should be no more
than 5mm through the far cortex of the
bone to reduce the risk of complications Fig. 22
associated with screw protrusion.
(Alternatively, the DRILL BIT and DRILL
SLEEVE can be removed and the SCREW
DEPTH GAUGE used to measure the
length of screw.)

Remove the DRILL BIT and DRILL SLEEVE.

Place the appropriate length 5.0mm
screw (color coded RED) through the
SCREW CANNULA into the bone (Fig. 22).

Using the screwdriver, advance the screw

to achieve bicortical purchase (the screw
head should sit on the near cortex of the
bone). The screws are self tapping so
Fig. 23
tapping should not be necessary (Fig.
23).
Fig. 22
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

SCREWDRIVER, 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.

Note: Do not overtighten the screws.

 Zimmer® Natural Nail® System - Tibial (Suprapatella) 11

Distal Targeting – Freehand Make a stab incision at this point and

Technique dissect down to the bone. Place the tip
8.3mm nails utilize a 4.0mm screw of the drill bit against the bone. Verify
(3.3mm drill bit) distally. These items are that the tip of the drill bit is in the center
color coded WHITE. of the hole. While keeping the tip of the
drill bit against the bone, move the other
9.3mm and larger diameter nails use a
end of the drill bit into other positions
5.0mm screw (4.3mm drill bit) distally.
and take additional fluoroscopic images
These items are color coded RED.
to verify the position of the tip in the
NOTE: There is no color indication on the center of the hole. Align the drill bit with
screw itself. Screw packaging and the the C-arm beam. Tap the drill bit into the
screw case contain color coding to help bone using the MALLET.
identify the screw size.
Loosen the SET SCREW and remove the
Insert the appropriate diameter DISTAL TARGETING WAND, leaving the
FREEHAND DRILL BIT into the DISTAL DRILL BIT in place. Slide the FREEHAND
TARGETING WAND. Finger tighten the SET TISSUE PROTECTION SLEEVE over the
SCREW. Position the C-arm in order to get DRILL BIT (Fig. 25).
a lateral view of the distal tibia. 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 (Fig. 24).
Fig. 25

Fig. 24
12 Zimmer® Natural Nail® System - Tibial (Suprapatella)

Attach the DRILL to the DRILL BIT and NOTE: Do not overtighten the screws.
advance the drill bit through the bone.
Repeat these steps to insert additional
Verify that the drill bit has gone through
distal screws.
the hole in the nail.

Remove the drill bit. Measure the depth

of the hole using the FREEHAND SCREW
DEPTH GAUGE (Fig. 26).

Alternatively, the appropriate length

of screw can be measured using the
numbered etch on the DRILL BIT closest
to the end of the FREEHAND TISSUE
PROTECTION SLEEVE when the DRILL
BIT is in the bone and the SLEEVE is
touching the bone (Fig. 27). Insert the
appropriate length screw using the Fig. 26
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.

CAUTION: If using the CAPTURED

SCREWDRIVER, 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.

Fig. 27
 Zimmer® Natural Nail® System - Tibial (Suprapatella) 13

Finalize Implant Placement Choose the appropriate height TIBIAL Postoperative Care
Observe the depth of the nail in proximal NAIL CAP. Secure the selected NAIL CAP Early range of motion exercises of the
tibia. Ridges in the targeting guide barrel to the NAIL CAP INSERTER using the NAIL knee and ankle are encouraged. Allow
indicate depths of 5, 10 and 15mm. CAP RETAINING SHAFT (Fig. 29). Slide the toe-touch weight bearing to progress
TIBIAL NAIL CAP over the 2.0MM PIN and to full weight bearing as fracture callus
Disconnect the TARGETING MODULE
tighten to the nail (Fig. 30). Using the increases on the x-ray films.
from the TARGETING GUIDE HANDLE and
C-arm, verify that the cap is completely
set aside. Place a 2.0MM PIN through
seated to the top of the nail.
the guide against the proximal screws. Nail Extraction
Loosen and remove the CONNECTING Disengage the NAIL CAP INSERTER from Because of the potential for damage
BOLT from the nail (Fig. 28). Remove the the TIBIAL NAIL CAP. Remove the 2.0MM to intra-articular structures, use a
TARGETING GUIDE HANDLE and set aside. GUIDE PIN. standard parapatellar incision for any
nail extractions. Do not extract the nail
Assemble the ENTRY CANNULA with the Close all wounds and apply the
via a suprapatellar approach. Before
blue ENTRY CANNULA HANDLE and slide appropriate dressings.
attempting to remove any screws or nail
over 2.0MM PIN.
caps, clean any bone from the hex of the
screw or cap.

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 the CONNECTING BOLT
INSERTER or another Zimmer 5.0mm hex
screwdriver. Expose the proximal screws
and use a 3.5mm hex screwdriver to
Fig. 28 remove them.

NOTE: Use the specific captured

screwdriver.

To remove the nail, slide a 2.0mm

Guide 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.

Fig. 30

Fig. 29
14 Zimmer® Natural Nail® System - Tibial (Suprapatella)

Tibial Nail Details

11mm proximal body diameter for 8.3, 9.3, 10 and 11mm nails. The
Anterior bevel proximal body diameter for 12mm nails is consistent with shaft diameter
at top of nail

Oblique Screw, descends with joint line (12 to 17mm from top)

Oblique Screw, ascending (20 to 25mm from top)

60mm proximal
body length Dynamization slot (28 to 44mm from top)

Transverse Screw (49 to 54mm from top)

10° Herzog curve

Tri-flute shape (10mm and up)

8.3, 9.3, 10, 11, 12mm

Shaft Diameters 4.0mm (Distal Holes of 8.3mm Nails Only)
7mm Diameter Head
3.9mm Head Height
3.4mm Minor Diameter
3.3mm Drill
1.8mm Tip Length

5.0mm
8mm Diameter Head
3.9mm Head Height
4.3mm Minor Diameter
4.3mm Drill
2.2mm Tip Length
2° anterior bow

25 to 30mm from tip

15 to 20mm from tip
5 to 10mm from tip
Posterior bevel on tip
 Zimmer® Natural Nail® System - Tibial (Suprapatella) 15

Case Examples

Pre-Op Post-Op

Pre-Op Post-Op
16 Zimmer® Natural Nail® System - Tibial (Suprapatella)

Product Information
Tibial Nails
Item Number Product Description

47-2495-240-08 Tibia Nail 8.3mm X 24cm Ti-6AL-4V Alloy 47-2495-360-10 Tibia Nail 10mm X 36cm Ti-6AL-4V Alloy
47-2495-260-08 Tibia Nail 8.3mm X 26cm Ti-6AL-4V Alloy 47-2495-380-10 Tibia Nail 10mm X 38cm Ti-6AL-4V Alloy

47-2495-280-08 Tibia Nail 8.3mm X 28cm Ti-6AL-4V Alloy 47-2495-400-10 Tibia Nail 10mm X 40cm Ti-6AL-4V Alloy

47-2495-300-08 Tibia Nail 8.3mm X 30cm Ti-6AL-4V Alloy 47-2495-420-10 Tibia Nail 10mm X 42cm Ti-6AL-4V Alloy

47-2495-320-08 Tibia Nail 8.3mm X 32cm Ti-6AL-4V Alloy 47-2495-440-10 Tibia Nail 10mm X 44cm Ti-6AL-4V Alloy

47-2495-340-08 Tibia Nail 8.3mm X 34cm Ti-6AL-4V Alloy 47-2495-240-11 Tibia Nail 11mm X 24cm Ti-6AL-4V Alloy

47-2495-360-08 Tibia Nail 8.3mm X 36cm Ti-6AL-4V Alloy 47-2495-260-11 Tibia Nail 11mm X 26cm Ti-6AL-4V Alloy

47-2495-380-08 Tibia Nail 8.3mm X 38cm Ti-6AL-4V Alloy 47-2495-280-11 Tibia Nail 11mm X 28cm Ti-6AL-4V Alloy

47-2495-400-08 Tibia Nail 8.3mm X 40cm Ti-6AL-4V Alloy 47-2495-300-11 Tibia Nail 11mm X 30cm Ti-6AL-4V Alloy

47-2495-420-08 Tibia Nail 8.3mm X 42cm Ti-6AL-4V Alloy 47-2495-320-11 Tibia Nail 11mm X 32cm Ti-6AL-4V Alloy

47-2495-440-08 Tibia Nail 8.3mm X 44cm Ti-6AL-4V Alloy 47-2495-340-11 Tibia Nail 11mm X 34cm Ti-6AL-4V Alloy

47-2495-240-09 Tibia Nail 9.3mm X 24cm Ti-6AL-4V Alloy 47-2495-360-11 Tibia Nail 11mm X 36cm Ti-6AL-4V Alloy

47-2495-260-09 Tibia Nail 9.3mm X 26cm Ti-6AL-4V Alloy 47-2495-380-11 Tibia Nail 11mm X 38cm Ti-6AL-4V Alloy

47-2495-280-09 Tibia Nail 9.3mm X 28cm Ti-6AL-4V Alloy 47-2495-400-11 Tibia Nail 11mm X 40cm Ti-6AL-4V Alloy

47-2495-300-09 Tibia Nail 9.3mm X 30cm Ti-6AL-4V Alloy 47-2495-420-11 Tibia Nail 11mm X 42cm Ti-6AL-4V Alloy

47-2495-320-09 Tibia Nail 9.3mm X 32cm Ti-6AL-4V Alloy 47-2495-440-11 Tibia Nail 11mm X 44cm Ti-6AL-4V Alloy

47-2495-340-09 Tibia Nail 9.3mm X 34cm Ti-6AL-4V Alloy 47-2495-240-12 Tibia Nail 12mm X 24cm Ti-6AL-4V Alloy

47-2495-360-09 Tibia Nail 9.3mm X 36cm Ti-6AL-4V Alloy 47-2495-260-12 Tibia Nail 12mm X 26cm Ti-6AL-4V Alloy

47-2495-380-09 Tibia Nail 9.3mm X 38cm Ti-6AL-4V Alloy 47-2495-280-12 Tibia Nail 12mm X 28cm Ti-6AL-4V Alloy

47-2495-400-09 Tibia Nail 9.3mm X 40cm Ti-6AL-4V Alloy 47-2495-300-12 Tibia Nail 12mm X 30cm Ti-6AL-4V Alloy

47-2495-420-09 Tibia Nail 9.3mm X 42cm Ti-6AL-4V Alloy 47-2495-320-12 Tibia Nail 12mm X 32cm Ti-6AL-4V Alloy

47-2495-440-09 Tibia Nail 9.3mm X 44cm Ti-6AL-4V Alloy 47-2495-340-12 Tibia Nail 12mm X 34cm Ti-6AL-4V Alloy

47-2495-240-10 Tibia Nail 10mm X 24cm Ti-6AL-4V Alloy 47-2495-360-12 Tibia Nail 12mm X 36cm Ti-6AL-4V Alloy

47-2495-260-10 Tibia Nail 10mm X 26cm Ti-6AL-4V Alloy 47-2495-380-12 Tibia Nail 12mm X 38cm Ti-6AL-4V Alloy

47-2495-280-10 Tibia Nail 10mm X 28cm Ti-6AL-4V Alloy 47-2495-400-12 Tibia Nail 12mm X 40cm Ti-6AL-4V Alloy

47-2495-300-10 Tibia Nail 10mm X 30cm Ti-6AL-4V Alloy 47-2495-420-12 Tibia Nail 12mm X 42cm Ti-6AL-4V Alloy

47-2495-320-10 Tibia Nail 10mm X 32cm Ti-6AL-4V Alloy 47-2495-440-12 Tibia Nail 12mm X 44cm Ti-6AL-4V Alloy

47-2495-340-10 Tibia Nail 10mm X 34cm Ti-6AL-4V Alloy

 Zimmer® Natural Nail® System - Tibial (Suprapatella) 17

4.0mm Screws (Partially Threaded) Fixed Angle (Fully Threaded)

(for distal screw holes on nails 8.3mm nail)
Item Number Product Description
All Screws have a 3.5mm Hex Head 47-2484-020-40 4.0mm Cortical Screw 20mm Length
Item Number Product Description
47-2484-022-40 4.0mm Cortical Screw 22.5mm Length
47-2483-020-40 4.0mm Cortical Screw 20mm Length
47-2484-025-40 4.0mm Cortical Screw 25mm Length
47-2483-022-40 4.0mm Cortical Screw 22.5mm Length
47-2484-027-40 4.0mm Cortical Screw 27.5mm Length
47-2483-025-40 4.0mm Cortical Screw 25mm Length
47-2484-030-40 4.0mm Cortical Screw 30mm Length
47-2483-027-40 4.0mm Cortical Screw 27.5mm Length
47-2484-032-40 4.0mm Cortical Screw 32.5mm Length
47-2483-030-40 4.0mm Cortical Screw 30mm Length
47-2484-035-40 4.0mm Cortical Screw 35mm Length
47-2483-032-40 4.0mm Cortical Screw 32.5mm Length
47-2484-037-40 4.0mm Cortical Screw 37.5mm Length
47-2483-035-40 4.0mm Cortical Screw 35mm Length
47-2484-040-40 4.0mm Cortical Screw 40mm Length
47-2483-037-40 4.0mm Cortical Screw 37.5mm Length
47-2484-042-40 4.0mm Cortical Screw 42.5mm Length
47-2483-040-40 4.0mm Cortical Screw 40mm Length
47-2484-045-40 4.0mm Cortical Screw 45mm Length
47-2483-042-40 4.0mm Cortical Screw 42.5mm Length
47-2484-047-40 4.0mm Cortical Screw 47.5mm Length
47-2483-045-40 4.0mm Cortical Screw 45mm Length
47-2484-050-40 4.0mm Cortical Screw 50mm Length
47-2483-047-40 4.0mm Cortical Screw 47.5mm Length
47-2484-052-40 4.0mm Cortical Screw 52.5mm Length
47-2483-050-40 4.0mm Cortical Screw 50mm Length
47-2484-055-40 4.0mm Cortical Screw 55mm Length
47-2483-052-40 4.0mm Cortical Screw 52.5mm Length
47-2484-057-40 4.0mm Cortical Screw 57.5mm Length
47-2483-055-40 4.0mm Cortical Screw 55mm Length
47-2484-060-40 4.0mm Cortical Screw 60mm Length
47-2483-057-40 4.0mm Cortical Screw 57.5mm Length
47-2484-065-40 4.0mm Cortical Screw 65mm Length
47-2483-060-40 4.0mm Cortical Screw 60mm Length
47-2484-070-40 4.0mm Cortical Screw 70mm Length
47-2483-065-40 4.0mm Cortical Screw 65mm Length
47-2484-075-40 4.0mm Cortical Screw 75mm Length
47-2483-070-40 4.0mm Cortical Screw 70mm Length
47-2484-080-40 4.0mm Cortical Screw 80mm Length
47-2483-075-40 4.0mm Cortical Screw 75mm Length
47-2484-085-40 4.0mm Cortical Screw 85mm Length
47-2483-080-40 4.0mm Cortical Screw 80mm Length
47-2484-090-40 4.0mm Cortical Screw 90mm Length
47-2483-085-40 4.0mm Cortical Screw 85mm Length
47-2484-095-40 4.0mm Cortical Screw 95mm Length
47-2483-090-40 4.0mm Cortical Screw 90mm Length
47-2484-100-40 4.0mm Cortical Screw 100mm Length
47-2483-095-40 4.0mm Cortical Screw 95mm Length

47-2483-100-40 4.0mm Cortical Screw 100mm Length

18 Zimmer® Natural Nail® System - Tibial (Suprapatella)

5.0mm Screws (Partially Threaded) Fixed Angle (Fully Threaded)

(for all proximal screw holes and distal screw holes on nails 9.3mm
Item Number Product Description
and larger)
47-2484-020-50 5.0mm Cortical Screw 20mm Length
Item Number Product Description
47-2484-022-50 5.0mm Cortical Screw 22.5mm Length
47-2483-020-50 5.0mm Cortical Screw 20mm Length
47-2484-025-50 5.0mm Cortical Screw 25mm Length
47-2483-022-50 5.0mm Cortical Screw 22.5mm Length
47-2484-027-50 5.0mm Cortical Screw 27.5mm Length
47-2483-025-50 5.0mm Cortical Screw 25mm Length
47-2484-030-50 5.0mm Cortical Screw 30mm Length
47-2483-027-50 5.0mm Cortical Screw 27.5mm Length
47-2484-032-50 5.0mm Cortical Screw 32.5mm Length
47-2483-030-50 5.0mm Cortical Screw 30mm Length

47-2483-032-50 5.0mm Cortical Screw 32.5mm Length 47-2484-035-50 5.0mm Cortical Screw 35mm Length

47-2483-035-50 5.0mm Cortical Screw 35mm Length 47-2484-037-50 5.0mm Cortical Screw 37.5mm Length

47-2483-037-50 5.0mm Cortical Screw 37.5mm Length 47-2484-040-50 5.0mm Cortical Screw 40mm Length

47-2483-040-50 5.0mm Cortical Screw 40mm Length 47-2484-042-50 5.0mm Cortical Screw 42.5mm Length

47-2483-042-50 5.0mm Cortical Screw 42.5mm Length 47-2484-045-50 5.0mm Cortical Screw 45mm Length

47-2483-045-50 5.0mm Cortical Screw 45mm Length 47-2484-047-50 5.0mm Cortical Screw 47.5mm Length

47-2483-047-50 5.0mm Cortical Screw 47.5mm Length 47-2484-050-50 5.0mm Cortical Screw 50mm Length

47-2483-050-50 5.0mm Cortical Screw 50mm Length 47-2484-052-50 5.0mm Cortical Screw 52.5mm Length

47-2483-052-50 5.0mm Cortical Screw 52.5mm Length 47-2484-055-50 5.0mm Cortical Screw 55mm Length

47-2483-055-50 5.0mm Cortical Screw 55mm Length 47-2484-057-50 5.0mm Cortical Screw 57.5mm Length

47-2483-057-50 5.0mm Cortical Screw 57.5mm Length 47-2484-060-50 5.0mm Cortical Screw 60mm Length

47-2483-060-50 5.0mm Cortical Screw 60mm Length 47-2484-065-50 5.0mm Cortical Screw 65mm Length

47-2483-065-50 5.0mm Cortical Screw 65mm Length 47-2484-070-50 5.0mm Cortical Screw 70mm Length

47-2483-070-50 5.0mm Cortical Screw 70mm Length 47-2484-075-50 5.0mm Cortical Screw 75mm Length

47-2483-075-50 5.0mm Cortical Screw 75mm Length 47-2484-080-50 5.0mm Cortical Screw 80mm Length

47-2483-080-50 5.0mm Cortical Screw 80mm Length 47-2484-085-50 5.0mm Cortical Screw 85mm Length

47-2483-085-50 5.0mm Cortical Screw 85mm Length 47-2484-090-50 5.0mm Cortical Screw 90mm Length

47-2483-090-50 5.0mm Cortical Screw 90mm Length 47-2484-095-50 5.0mm Cortical Screw 95mm Length

47-2483-095-50 5.0mm Cortical Screw 95mm Length 47-2484-100-50 5.0mm Cortical Screw 100mm Length

47-2483-100-50 5.0mm Cortical Screw 100mm Length

Nail Caps
Item Number Product Description

47-2487-005-00 Tibial Nail Cap 0mm Height

47-2487-005-05 Tibial Nail Cap 5mm Height

47-2487-005-10 Tibial Nail Cap 10mm Height

47-2487-005-15 Tibial Nail Cap 15mm Height

 Zimmer® Natural Nail® System - Tibial (Suprapatella) 19

Instruments
KT-2490-005-00 – SMALL Tibia Nail Instrument Set
Item Number Product Description

02.00020.049 Ratchet Wrench 11mm 00-2490-035-75 Freehand Modular 3.5mm Hex Screwdriver

00-2237-008-00 Skin Protector 00-2490-046-20 2.0mm Pin

00-2490-000-14 Connecting Knob 00-2490-012-30 3.0mm Threaded Pin

00-2490-000-30 Nail Diameter Gauge 00-2490-046-32 Guide Pin Inserter / Extractor

00-2490-000-33 Ruler 00-2490-050-00 Modular Handle AO

00-2490-000-34 Nail Length Gauge 00-2490-050-02 Modular T-Handle

00-2490-000-41 Hole Indicator 00-2490-051-80 Screw Cannula 8.0mm

00-2490-005-01 Small Tibial Connecting Bolt 00-2490-052-80 Screw Trocar 8.0mm

00-2490-005-05 Tibial Module 00-2490-053-43 Tibial Drill Sleeve 4.3mm

00-2490-005-10 Tibial Targeting Guide Small Handle 00-2490-054-43 Calibrated Drill 4.3mm Tibial

00-2490-005-49 Tibial Axial Compression Device 00-2490-065-80 Short Screw Depth Gauge 8.0mm

00-2490-010-01 Short Cannulated Awl 00-2490-070-00 Freehand Targeting Wand

00-2490-010-02 7mm Diameter Awl - Angled Tip 00-2490-070-01 Targeting Wand Set Screw

00-2490-012-00 Guide Wire Gripper 00-2490-072-33 3.3mm Freehand Targeting Drill

00-2490-014-80 Entry Reamer 8mm 00-2490-072-43 4.3mm Freehand Targeting Drill

00-2490-017-00 Guide Wire Pusher 00-2490-073-00 Freehand Targeting Depth Gauge

00-2490-031-00 Connecting Bolt Inserter 00-2490-074-00 Freehand Tissue Protection Sleeve

00-2490-031-05 11mm Hex/ Pin Wrench 00-2490-080-00 Nail Cap Inserter

00-2490-032-00 Impaction Head 00-2490-080-03 Nail Cap Retaining Shaft

00-2490-032-01 Slotted Mallet 00-2490-090-00 Cannulated Extraction Adapter 5/16”

00-2490-033-00 Slap Hammer Adapter 00-5900-099-00 Case Lid

00-2490-035-50 Modular Screwdriver 3.5mm Hex

00-2490-035-62 Short 3.5mm Hex Screwdriver - Captured

Freehand 3.5mm Hex Screwdriver -

00-2490-035-72 Captured
20 Zimmer® Natural Nail® System - Tibial (Suprapatella)

KT-2490-005-01 – TALL Tibia Nail Instrument Set

00-2490-051-80 Screw Cannula 8.0mm
Item Number Product Description
00-2490-052-80 Screw Trocar 8.0mm
02.00020.049 Ratchet Wrench 11mm
00-2490-053-43 Tibial Drill Sleeve 4.3mm
00-2237-008-00 Skin Protector
00-2490-054-43 Calibrated Drill 4.3mm Tibial
00-2490-000-14 Connecting Knob
00-2490-065-80 Short Screw Depth Gauge 8.0mm
00-2490-000-30 Nail Diameter Gauge
00-2490-070-00 Freehand Targeting Wand
00-2490-000-33 Ruler
00-2490-070-01 Targeting Wand Set Screw
00-2490-000-34 Nail Length Gauge
00-2490-072-33 3.3mm Freehand Targeting Drill
00-2490-000-41 Hole Indicator
00-2490-072-43 4.3mm Freehand Targeting Drill
00-2490-005-05 Tibial Module
00-2490-073-00 Freehand Targeting Depth Gauge
00-2490-005-07 Tall Tibial Connecting Bolt
00-2490-074-00 Freehand Tissue Protection Sleeve
00-2490-005-13 Tibia Targeting Guide Tall Handle
00-2490-080-00 Nail Cap Inserter
00-2490-005-49 Tibial Axial Compression Device
00-2490-080-03 Nail Cap Retaining Shaft
00-2490-010-01 Short Cannulated Awl
00-2490-090-00 Cannulated Extraction Adapter 5/16”
00-2490-010-02 7mm Diameter Awl - Angled Tip
00-5900-099-00 Case Lid
00-2490-012-00 Guide Wire Gripper

00-2490-014-80 Entry Reamer 8mm

00-2490-017-00 Guide Wire Pusher KT-2490-005-10 Suprapatellar Add-on Instrument Set

00-2490-031-00 Connecting Bolt Inserter Item Number Product Description

00-2490-031-05 11mm Hex / Pin Wrench 00-2490-005-21 Long Tibial Connecting Bolt

00-2490-032-00 Impaction Head 00-2490-005-20 Long Tibial Targeting Guide Handle

00-2490-032-01 Slotted Mallet 00-2490-010-06 Modular Straight Awl, cannulated

00-2490-033-00 Slap Hammer Adapter 00-2490-013-05 Long Tibial Entry Cannula, Locking

00-2490-035-50 Modular Screwdriver 3.5mm Hex 00-2490-013-06 Starting Point Modifier, Locking

00-2490-035-62 Short 3.5mm Hex Screwdriver - Captured 00-2490-051-20 Cannulated Trocar, Locking

Freehand 3.5mm Hex Screwdriver - 00-2490-013-07 Long Tibial Entry Cannula Handle
00-2490-035-72 Captured
00-5900-099-00 Case Lid
00-2490-035-75 Freehand Modular 3.5mm Hex Screwdriver

00-2490-046-20 2.0mm Pin

00-2490-012-30 3.0mm Threaded Pin

00-2490-046-32 Guide Pin Inserter / Extractor

00-2490-050-00 Modular Handle AO

00-2490-050-02 Modular T-Handle

 Zimmer® Natural Nail® System - Tibial (Suprapatella) 21

Instrument Cases (Select both “Stainless Steel” or KT-2490-020-00 – Reduction Instrument Set
both “Stainless Steel and Aluminum” Cases) Item Number Product Description

Item Number Product Description 00-2490-020-30 3.0mm Self Drilling Reduction Pin
Tibial Case 1 of 2 – Stainless Steel
00-2490-075-50 00-2490-020-50 5.0mm Self Drilling Reduction Pin
and Aluminum
Tibial Case 2 of 2 – Stainless Steel 00-2490-021-00 Ball Spike Pusher
00-2490-079-50
and Aluminum
00-2490-022-01 Bone Clamp
00-2490-075-00 Tibial Case 1 of 2 – Stainless Steel
00-2490-022-02 Verbrugge Clamp
00-2490-079-00 Tibial Case 2 of 2 – Stainless Steel
00-2490-022-03 Reduction Tong
00-2490-075-20 Suprapatella Tibia Instrument Add-on Case
00-2490-025-24 Bone Hook Small - 24mm

00-2490-025-34 Bone Hook Large - 34mm

Optional Instruments
00-2490-026-00 Reduction Rod
Item Number Product Description

00-2490-014-12 Entry Reamer 12mm 00-2490-050-00 Modular T-Handle AO

00-2490-060-50 Reduction Base and Tray

00-5900-099-00 Case Lid

Tear Drop Guide Wire (available separately)
Item Number Product Description

3.0mm x 100cm Tear Drop Guide Wire

47-2490-097-00 Surgical Technique Lit. No. 97-2495-009-00
(Sterile)
2.4mm x 100cm Tear Drop Guide Wire Wall Chart Lit. No. 97-2495-003-00
47-2490-097-01
(Sterile)
X-ray Templates Lit. No. 97-2495-050-00
3.0mm x 70cm Tear Drop Guide Wire
47-2490-098-00
(Sterile)
2.4mm x 70cm Tear Drop Guide Wire
47-2490-098-01
(Sterile)
22 Zimmer® Natural Nail® System - Tibial (Suprapatella)
Zimmer® Natural Nail® System - Tibial (Suprapatella) 23
FAi DRAFT July 20, 2015 3:25 PM

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.

97-2495-009-00 Rev. 3 6-26-15 Printed in USA ©2015 Zimmer, Inc.