MIS Radiolucent Targeting Device NCB Periprosthetic Femur Plate System Surgical Technique 97 2370 101 00 1

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MIS Radiolucent

Targeting Device

NCB® Periprosthetic

Femur Plate System

Surgical Technique

NCB® Periprosthetic MIS Radiolucent Targeting Device 3

Table of Contents

Introduction 4

Proximal NCB Periprosthetic MIS Technique 6

Insertion of the Proximal NCB Plate

Distal NCB Periprosthetic MIS Technique 7

Insertion of the Distal NCB Plate 7

Secure the Safety Lock Pin 8

Reduction of the Metaphyseal Bone Fragments 8

Insertion of the NCB Screws in Diaphyseal Bone 9

Creating Compression between the Plate and the Bone 11

4NCB® Periprosthetic MIS Radiolucent Targeting Device

This surgical technique is intended to

be used in conjunction with the NCB

Periprosthetic Femur Plate System Surgical

Technique (06.02013.012).

Introduction

Fully radiolucent Targeting Devices are

available, allowing MIS techniques to be

used for the NCB Periprosthetic Proximal

Femur and NCB Periprosthetic Distal

Femur Plates. The addition of Bottom

Covers provides proper targeting

according to plate size by blocking

holes that do not correspond to

the plate (Fig. 1&2). Each plate

length and type has a unique

Bottom Cover that targets its

hole pattern.

NOTE: Use of the Targeting

Device prevents polyaxial

screw insertion.

Fig. 1

Fig. 2 NCB Periprosthetic Femur Plates and NCB MIS Radiolucent Targeting Device

with Bottom Covers

NCB® Periprosthetic MIS Radiolucent Targeting Device 5

MIS Technique - Targeting

Device Assembly for

Insertion

Thread the Connection Bolt (REF

02.00024.380) through the NCB

Periprosthetic Targeting Device (Fig. 3).

Attach the Targeting Device by screwing

the connection bolt into the NCB

Periprosthetic Femur Plate. Attach the

NCB Periprosthetic Targeting Device to

the corresponding NCB Periprosthetic

Plate. (Left Proximal REF 02.00024.371;

Left Distal REF 02.00024.373 ; Right

Proximal REF 02.00024.370; Right

Distal REF 02.00024.372). Screw

the Connection Bolt into the NCB

Periprosthetic Plate and tighten with the

6Nm Torque Limiting Screwdriver (REF

02.00024.021).

Choose the appropriate Bottom Cover

(Proximal REF 02.00024.390-394; Distal

REF 02.00024.395-399) by matching

the plate size with the number of holes

indicated on the Bottom Cover for the

plate (Fig. 4). Snap it into the bottom of

the Targeting Device.

21 hole 12 hole

Proximal

Fig. 4 Each plate length and type uses a unique Bottom Cover to match its

specific hole pattern. For reference, the 21 hole and 12 hole proximal plates

with corresponding bottom covers are shown above.

Right Left

The Bottom Cover is flipped over for

right or left application.

Fig. 3 The Connection Bolt is first threaded into the top of the Targeting Device to

prevent it from falling out.

6NCB® Periprosthetic MIS Radiolucent Targeting Device

Proximal NCB

Periprosthetic MIS

Technique

Make the incision using a lateral

subvastus approach. Alternately,

incorporate the existing incision if

applicable. Avoid excessive stripping of

the soft tissue and keep the periosteum

intact.

Reduce the fracture prior to inserting the

plate. Bone fragments can be secured

with 2.0mm K-wires (REF 290.20.280)

or clamps, such as pointed reduction

forceps. Ensure that preliminary fixation

devices do not interfere with the future

location of the plate and screws,

with the prosthesis or with the NCB

Periprosthetic Targeting Device.

Insertion of the Proximal NCB Plate

1. Insert the plate between the vastus

lateralis muscle and the periosteum.

Place the Proximal Femur Plate just

below the vastus tubercle until you

achieve good contact with the bone.

Keep the distal end of the plate in

close contact with the bone during

insertion. Ensure both proximal and

distal ends of the plate have good

placement on the bone.

2. Make a stab incision at the most

distal plate hole. Insert the NCB

Trocar (REF 02.00024.062) and

Stabilization Bolt (REF 02.00024.074)

into the NCB Periprosthetic Plate (Fig.

5). Use the three K-wire holes to hold

the targeting device in place, ensuring

that the targeting device does not

sag. Depending on the patient

anatomy, these K-wires may rest on

the anterior aspect of the femur when

the plate is centered on the bone.

NOTE: To place a screw in the distal

end of the plate, exchange out the NCB

Stabilization Bolt with the NCB Trocar,

Drill Guide, and Tissue Protection

Sleeve assembly after all other screws

have been inserted.

Fig. 5

Additional K-wire holes

NCB® Periprosthetic MIS Radiolucent Targeting Device 7

Distal NCB Periprosthetic

MIS Technique

A lateral incision is recommended. The

skin incision should start at Gerdy’s

tubercle and extend proximally. The

muscles are left attached to the fracture

fragments for optimal blood supply. Do

not strip the periosteum.

Reduce the fracture prior to inserting the

plate. Bone fragments can be secured

with 2.0mm K-wires (REF 290.20.280)

or clamps, such as pointed reduction

forceps. Ensure that preliminary fixation

devices do not interfere with the future

location of the plate and screws,

with the prosthesis or with the NCB

Periprosthetic Targeting Device.

Insertion of the Distal NCB Plate

1. Insert the plate between the vastus

lateralis muscle and the periosteum.

Keep the proximal end of the plate in

close contact with the bone during

insertion. Place the distal end of the

plate as distal as possible. Ensure

both proximal and distal ends of the

plate have good placement on the

bone.

2. Make a stab incision at the most

proximal plate hole. Insert the NCB

Trocar (REF 02.00024.062) and

Stabilization Bolt (REF 02.00024.074)

into the NCB Periprosthetic Plate

(Fig. 6). Use the three K-wire holes

to hold the targeting device in place,

ensuring that the targeting device

does not sag. Depending on the

patient anatomy, these K-wires may

rest on the anterior aspect of the

femur when the plate is centered on

the bone.

NOTE: To place a screw in the proximal

end of the plate, exchange out the NCB

Stabilization Bolt with the NCB Trocar,

Drill Guide, and Tissue Protection

Sleeve assembly after all other screws

have been inserted.

Fig. 6

Additional K-wire holes

8NCB® Periprosthetic MIS Radiolucent Targeting Device

Proximal & Distal NCB

Periprosthetic MIS

Technique (cont'd)

Secure the Safety Lock Pin

Insert the NCB Periprosthetic Safety Lock

Pin (REF 02.00024.382) into the NCB

Periprosthetic Targeting Device from the

anterior side to ensure proper distance

is maintained between the Targeting

Device and the

plate throughout the

procedure (Fig. 7).

To ensure the Pin

is locked in place, adjust the distance

between the end of the Targeting Device

and the end of the plate by gently

pushing on the Targeting Device.

Reduction of the Metaphyseal

Bone Fragments

Insert screws into the metaphyseal area

of the plate using the open technique on

page 20 of the NCB Periprosthetic Femur

Plate System Surgical Technique.

NOTE: 15o angulation may be

restricted when inserting screws in the

metaphyseal region with the Targeting

Device attached to the plate.

NOTE: Some Locking Caps near the

metaphyseal region must be placed

after the Targeting Device has been

removed from the plate.

Fig. 7 Adjust the height of the Targeting Device to allow Safety Lock Pin placement.

NCB® Periprosthetic MIS Radiolucent Targeting Device 9

Insertion of the NCB Screws in

Diaphyseal Bone

1. Make a stab incision to access the

plate hole. Insert the NCB Trocar,

Drill Guide, and Tissue Protection

Sleeve assembly (REF 02.00024.060-

062) (Fig. 8).

2. Screw the Tissue Protection Sleeve

into the NCB Periprosthetic Targeting

Device. The Tissue Protection Sleeve

will be in direct contact with the

plate.

3. Screw the Drill Guide into the plate

hole.

4. Remove the Trocar.

Fig. 8

Trocar

Drill Guide

Tissue Protection Sleeve

NCB® Periprosthetic MIS Radiolucent Targeting Device

Fig. 9

Fig. 10

5. Insert the correct diameter Drill Bit

for the desired screw. The same

Drill Guide is used for both the 3.3mm

and 4.3mm drill bits. The calibration

lines on the Drill Bit can be used to

determine the screw length (Fig. 9).

Alternatively, determine the screw

length using the NCB Depth Gauge

(REF 02.00024.006) by measuring

through the Drill Guide and Tissue

Protection Sleeve (Fig. 10).

NOTE: Ensure that other existing

medical devices and their fixation and/

or anchorage elements are not affected

or damaged by drill bits, taps, or

screws. Do not hit the prosthesis with

the tip of the drill, tap, or screw.

NCB® Periprosthetic MIS Radiolucent Targeting Device

6. Remove the Drill Guide and insert

the appropriate screw using the

NCB Hexagonal Screwdriver

(REF 02.00024.023) (Fig. 11).

NOTE: If the screw is inserted using

power, final tightening should be

done by hand.

7. To lock the screw, insert a Locking

Cap (REF 02.03150.300) and tighten

the Cap with the 6Nm Torque Limiting

Screwdriver (REF 02.00024.021) until

a clicking sound is heard (Fig. 12).

NOTE: The Self-Retaining Screwdriver

(REF 5912) can be used to prevent

screws and Locking Caps from being

lost inside the Tissue Protection Sleeve,

however the NCB hexagonal screwdriver

may be needed to insert the Screw. Final

tightening of the Locking Caps must

always be done using the 6Nm Torque

Limiting Screwdriver.

Fig. 11

Fig. 12

NCB® Periprosthetic MIS Radiolucent Targeting Device

(Optional)

Creating Compression between

the Plate and the Bone

1. Screw the Reduction Spin Knob (REF

00-2360-011-03) onto the threads

nearest to the AO adapter on the

Plate Reduction Instrument (REF

00-2360-011-01).

2. Insert the NCB Trocar, Drill Guide, and

Tissue Protection Sleeve Assembly as

described in steps 1-4 from the section

entitled "Insertion of the NCB Screws in

Diaphyseal Bone" on page 9.

3. Drill the Plate Reduction Instrument

into the bone.

4. Turn the Spin Knob against the Drill

Guide until it provides the desired

amount of compression (Fig. 14).

8. Remove the Tissue Protection

Sleeve and place a Screw Marker

(02.00024.077) into the hole in the

NCB Periprosthetic Targeting Device

to indicate which plate holes contain

screws (Fig. 13).

9. Repeat the above steps as needed to

insert additional screws.

Fig. 13

Fig. 14

Plate Reduction Instrument

Reduction Spin Knob

NCB® Periprosthetic MIS Radiolucent Targeting Device 13

Product Information – MIS Guides and Instruments

NCB® Periprosthetic MIS Instruments

REF Description

02.00002.001 Assembly Pin

02.00024.003 NCB-PT Drill Bit 4.3MM QC

02.00024.006 NCB-DF Depth Gauge

02.00024.060 NCB-DF Soft Tissue Protection Sleeve 10.0/8.2MM

02.00024.061 NCB-DF Drill Guide 8.2/4.3MM

02.00024.062 NCB-DF Trocar

02.00024.074 NCB-DF Stabilization Bolt

02.00024.077 NCB-PT Screw Marker

02.00024.370 NCB Periprosthetic Femur targeting device, right proximal

02.00024.371 NCB Periprosthetic Femur targeting device, left proximal

02.00024.372 NCB Periprosthetic Femur targeting device, right distal

02.00024.373 NCB Periprosthetic Femur targeting device, left distal

02.00024.380 NCB Periprosthetic Femur connection bolt for targeting device

02.00024.381 NCB Periprosthetic Femur MIS drill bit Ø 3.3mm, with quick coupling

02.02024.381 NCB Periprosthetic Femur MIS drill bit Ø 3.3mm, with quick coupling (sterile)

02.00024.382 NCB Periprosthetic Femur Safety Lock Pin

02.00024.390 NCB Periprosthetic Proximal Femur targeting device bottom cover for 9 hole plate

02.00024.391 NCB Periprosthetic Proximal Femur targeting device bottom cover for 12 hole plate

02.00024.392 NCB Periprosthetic Proximal Femur targeting device bottom cover for 15 hole plate

02.00024.393 NCB Periprosthetic Proximal Femur targeting device bottom cover for 18 hole plate

02.00024.394 NCB Periprosthetic Proximal Femur targeting device bottom cover for 21 hole plate

02.00024.395 NCB Periprosthetic Distal Femur targeting device bottom cover for 9 hole plate

02.00024.396 NCB Periprosthetic Distal Femur targeting device bottom cover for 12 hole plate

02.00024.397 NCB Periprosthetic Distal Femur targeting device bottom cover for 15 hole plate

02.00024.398 NCB Periprosthetic Distal Femur targeting device bottom cover for 18 hole plate

02.00024.399 NCB Periprosthetic Distal Femur targeting device bottom cover for 21 hole plate

00-2360-011-01 Plate Reduction Instrument

00-2360-011-03 Reduction Spin Knob

5912 Self-Retaining Screwdriver

Graphic Cases for NCB Periprosthetic MIS Instruments

Standard Graphic Cases

REF Description

02.00024.913 NCB Periprosthetic Femur MIS Case Assembly

02.00024.914 NCB Periprosthetic Femur MIS Case Base

02.00024.915 NCB Periprosthetic Femur MIS Case Tray

00-5900-099-00 Generic Lid

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 advice in whole or

in part. Please refer to the package inserts for important product information, including, but not

limited to, 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.

MIS Radiolucent Targeting Device NCB Periprosthetic Femur Plate System Surgical Technique 97 2370 101 00 1

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