Surgical Technique for ZMS Recon Nail

Nailing Procedure

Step I-- Creating the Entry Portal

The starting pointand entry portal in the piriformis fossa is the key to the entire operation.Place the Femoral Awl in the anterior portion of the piriformis fossa approximately5 mm anterior to the position you would choose when doing a standard femoralnailing (click image to enlarge). This will facilitate screw placementin the center of the femoral neck. Check the position of the Awl with bothAP and lateral images before creating the portal. On the AP image, the Awlshould lie at the base of the femoral neck adjacent to the greater trochanter.On the lateral view, it should be oriented just posterior to the centerof the femoral neck. When the correct position is achieved, rotate the Awlto create the entry portal for the Bulbtipped Guide Wire.

An alternative method is to insert a 3.2 mm Steinmann pin into the piriformisfossa while checking the position with AP and lateral image intensification.The Steinmann pin must lie at the base of the femoral neck just medial tothe greater trochanter on the AP view, and oriented just posterior to thecenter of the femoral neck on the lateral view. Seat the Steinmann pin wellinto the proximal femur and use the optional 9 mm Trochanteric Reamer tocreate the entry portal (click image to enlarge).