NCB Large Fragment System Surgical Technique

2016-04-01

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NCB®
Large Fragment
System

Surgical Technique

3

NCB® Large Fragment System – Surgical Technique

Table of Contents
Introduction	4
System Features	

7

Indications and Contraindications	

10

NCB Large Fragment Plate Positioning and Screw Fixation	

10

NCB Screw Insertion	

12

NCB Curved Femur Shaft Plate – Surgical Technique	

14

NCB Straight Narrow Shaft Plate – Surgical Technique	

19

Tips and Tricks for the NCB Large Fragment System	

24

Post-Operative Treatment	

25

Implant Removal	

25

Product Information – Implants	

26

Product Information – Instruments	

29

Planning Aid	

31

4

NCB® Large Fragment System – Surgical Technique

Introduction

The NCB (Non-Contact Bridging) Large
Fragment System is a line of polyaxial
locking plates for the treatment of femur,
tibia and humerus shaft fractures. It consists of a Curved Femur Shaft plate and a
Straight Narrow Shaft plate.
The NCB Curved Femur Shaft plate is also
included in the NCB Periprosthetic Femur
Polyaxial Locking Plate System.

NCB Curved Femur Shaft Plate

NCB Straight Narrow Shaft Plate

5

NCB® Large Fragment System – Surgical Technique

The NCB System Technology allows for
polyaxial screw placement (30° cone)
with screw locking achieved through the
use of locking caps that are threaded into
the plate holes. The locking construct
allows for improved stability especially
in osteopenic bone. Before locking,
the screws can act as lag screws and
be used for fracture reduction; a benefit
which is not offered with standard
locking systems.

In the locked mode, the NCB Large Fragment Plate acts as an internal fixator
without contact between the plate and
the bone surface, which may reduce the
risk of periosteal blood supply impairment. This Non-Contact Bridging concept
can also be controlled specifically
through the use of 1, 2, or 3mm spacers,
which are threaded into the plate holes
prior to plate insertion.

30°
NCB 30° Cone Polyaxiality

Non
contact

Angular stability with the NCB Locking Caps

Locking cap ∅ 8mm

Blind screw insert

NCB Non-Contact Bridging

Spacer 1 to 3 mm

6

NCB® Large Fragment System – Surgical Technique

The surgical technique is based on wellknown standard plate osteosynthesis
techniques, which give the surgeon
tactile feedback regarding bone quality
during drilling and tightening of the
screws. In addition, with the use of
locking caps the screws can be locked
and made angularly stable.
The NCB Large Fragment System allows
for extensive flexibility in the treatment of
simple shaft fractures including periprosthetic fractures in the shaft. The polyaxial
NCB Plate technology, may allow for
bicortical screw fixation around the stem
of the implanted prosthesis. In this way,
the surgeon can achieve better construct
stability than with cables with less
­damage to the soft tissue. And because
of the Non-Contact Bridging concept, the
risk to the periosteal blood supply may
be reduced.

Bicortical screw anchorage
(with or without IM device
inside) with NCB Screws

Additionally, fixation using cables and
cable buttons is possible for those cases
where bicortical screw fixation cannot be
achieved. Both techniques (locking
screws and cables) may also be combined. Blunt tip unicortical NCB Screws
are also available, creating a system
which offers comprehensive solutions for
these difficult fractures.

Fixation using uni- and
­bicortical screws,
as well as cables and
cable buttons

7

NCB® Large Fragment System – Surgical Technique

System Features
NCB Curved Femur Shaft Plate and
NCB Straight Narrow Shaft Plate
Symmetric Design
One plate for left and right long bones
due to symmetric design.
The NCB Straight Narrow Shaft Plate can
either be used for the tibia or humerus.
Whereas the NCB Curved Femur Shaft
Plate is ­specifically designed for the
femur.

Articulated Tension Device Hole

Compression Slots
Two compression slots allow 1mm
of compression each.

K-Wire Holes
Compression Slots

K-Wire Holes
Two k-wire holes at each end of the plate
allow easier preliminary plate fixation.
Articulated Tension Device Holes
(only NCB Curved Femur Shaft Plate)
One hole at each end of the plate allows
for connection of the Articulated Tension
Device to achieve additional compression,
if needed.

Screw Options
Broad Screw Options
Three different NCB Screw types are
offered with the NCB Large Fragment
System, to allow both bicortical and
unicortical fixation.

Articulated Tension Device Hole

Broad Screw Options	

∅ mm	

Description

	

5	

NCB Screws

	

5	

NCB Unicortical Screws

	

4	

NCB Screws

	

3.5	

Cortical Screws

3.5mm cortical screws are included for
additional fixation outside the NCB
Plates.

Specific Instruments for Periprosthetic
Fractures
Slightly oversized drill bits and drill guides
are offered with the NCB Large Fragment
System, to reduce the risk of cracks in
the cement mantle when placing screws
around a cemented prosthesis.

NCB Instruments for overdrilling into cement

8

NCB® Large Fragment System – Surgical Technique

NCB Bone Spacers (Optional)
Use at least two bone spacers in the
diaphyseal area of all NCB Plates, to
avoid contact of the plate with the bone
surface reducing the risk of periosteal
blood supply impairment.

Two NCB Bone Spacers used
in the diaphyseal area of
a NCB Plate, to avoid contact
of the plate with the bone
(Non Contact Bridging)

The spacers may also be used if the
fracture has been reduced using a cable,
to avoid contact between the
plate and the cable.
The spacers are available in 1mm, 2mm
and 3mm (REF 02.03150.311 to 313)
sizes.

Spacer 1 to 3 mm

Note: Insert the bone spacers into the
NCB Plate or Screw holes before plate
insertion. The spacers are single use only,
and they can be removed after locking
the screws.

NCB Blind Screw Inserts (Optional)
To prevent bone ingrowth into empty NCB
Screw holes, use the NCB Blind Screw
inserts (REF 02.03150.310).

NCB Blind Screws inserted in
a NCB Plate to prevent bone
ingrowth

Note: Hand tighten only.
Blind screw insert

9

NCB® Large Fragment System – Surgical Technique

Cable Fixation Options
The following products from the Zimmer®
Cable-Ready® Cable Grip
System are compatible with the NCB
Large Fragment System:

NCB Locking Plate
Cable Button, 2.5mm, Hex Drive

Hex Button, 3.5mm

Cable Assembly Cerclage,
1.8mm

• Sterile
• Material: Ti-6Al-4V
(Tivanium® Alloy)

• Sterile
• Material: C.P. Titanium

• Sterile
• Material: CoCr

REF 00-2232-002-35

REF 00-2232-002-28
REF 00-2232-004-18

REF 47-2232-060-01
Application
This Cable Button is threaded
directly into the NCB Plate to
provide a positioning point for
the Cable

Cable Fixation Options

Application
This Hex Button fits into the
standard hex in the screw head
(3.5mm hex). Therefore, it can
be inserted into the NCB Screw
head, or into the NCB Locking Cap

Cable Fixation with
Cable Button

Cable Fixation with
Hex Button

10

NCB® Large Fragment System – Surgical Technique

Indications and Contraindications
Indications
The NCB Periprosthetic Femur Polyaxial
Locking Plate System is indicated for
temporary internal fixation and stabilization of fractures and osteotomies of long
bones, including:
•	Periprosthetic fractures
•	Comminuted fractures
•	Supracondylar fractures
•	Fractures in osteopenic bone
•	Nonunions
•	Malunions

Contraindications
The NCB Straight Narrow Shaft Plate
is indicated for temporary internal
­fixation and stabilization of humeral and
tibial shaft fractures and osteotomies,
including:
•	Periprosthetic fractures
•	Comminuted fractures
•	Fractures in osteopenic bone
•	Nonunions
•	Malunions

•	All concomitant diseases that may
	 impair the fixation of the implant and/	
	 or the success of the intervention
•	Lack of bone substance or poor bone 	
	 quality which makes stable seating of 	
	 the implant impossible
•	Acute or chronic, local or systemic 		
	infections
•	Allergy to the implanted materials
•	Severe muscular, neural or vascular
	 diseases that endanger the extremities 	
	involved
•	Loose prosthesis, which requires
	 immediate revision.

NCB Large Fragment Plate Positioning and Screw Fixation
Recommended Plate Positioning
• Ensure that the length of the NCB
Curved Femur Shaft Plate or NCB
Straight Narrow Shaft Plate allows for
screw placement proximal and distal of
the ­fracture zone and if present around
the existing prosthesis.

11

NCB® Large Fragment System – Surgical Technique

Recommended NCB Screw
Fixation
The NCB Large Fragment System offers
three different types of polyaxial locking
screws, two of them are designed for
bicortical purchase, and one of them is
designed for unicortical purchase.

Recommended NCB Screw usage for NCB
Curved Femur Shaft Plate:
• Wherever possible, use 5.0mm bicortical NCB Screws.
• In periprosthetic fractures use two
bicortical 5.0mm NCB Screws close to
the fracture on each side of the fracture.
• For thin cortical bone near the prosthesis, the 4.0mm NCB Screws may be
used.

NCB Screws – Bicortical
Screw Type

Recommended NCB Screw usage for NCB
Straight Narrow Shaft Plate:
• Use 4.0mm bicortical NCB Screws
­wherever possible.

Unicortical

Cortical
5mm

Cortical
4mm

Cortical
Blunt Tip

Cortical
3.5mm

5mm

4mm

5mm

3.5mm

Core ∅

4.4mm

3.4mm

4.4mm

2.4mm

Length

22–85mm

20–70mm

10–20mm

20–40mm

02.03150.0xx
02.02150.0xx

02.03155.0xx
02.02155.0xx

02.03151.0xx
02.02151.0xx

00-4935-0xx-01
47-4935-0xx-01

Close to the fracture
area, in the shaft
area, or in case of a
periprosthetic fracture
where there is
no risk of hitting the
prosthesis

In tibia or humerus
bone and in case of a
periprosthetic fracture
away from the fracture
area to achieve bicortical fixation around the
prosthesis

For use when
bicortical fixation
cannot be achieved

Fixation of additional
bone fragments

Warning
If only unicortical
screws are used,
the use of cables is
required

Note: These screws can
be placed only outside
of the NCB Plates

4.3 / 4.5mm

3.3 / 3.5mm

4.3 / 4.5mm

2.5 / 3.5mm

Drill Bit REF

02.00024.002
02.00024.330

02.00024.118
02.00024.325

02.00024.002
02.00024.330

00-4806-110-25
00-4806-110-35

Tap REF

02.00024.341

02.00024.340

02.00024.341

00-4811-110-35

Drill Guide REF

02.00024.011
02.00024.331

02.00024.111
02.00024.326

02.00024.011
02.00024.331

00-4808-035-01

Outer ∅

REF
REF Sterile
Application

Drill Bit ∅

NCB Screw portfolio for the NCB Large Fragment System	

12

NCB® Large Fragment System – Surgical Technique

NCB Screw Insertion
For All Types of NCB Screws and
NCB Locking Caps
• Take care to avoid collision of the
screws by choosing the appropriate
plate holes and screw lengths.
• Press the NCB Drill Guide into the plate
hole perpendicular to the plate and
then tilt it in the preferred direction.
The drill guide needs to be in constant
contact with the bottom ring of the
hole. The guide limits the angulation to
15° from the perpendicular axis of the
plate or a cone of 30° for placing a
locked NCB Screw. Always use the drill
guide since it prevents selection of an
excessive screw angle and failure of
subsequent locking.
• Screws may be inserted under power
but should be final tightened by hand
only.
Note: Screws should not be locked until
both sides of the fragment have been
fixed.
• Lock the construct, insert and
tighten the NCB Locking Caps
(REF 02.03150.300) by using the NCB
Torque Limiting Screwdriver, 6Nm
(REF 02.00024.021) until a click sound
is heard. Make sure the screwdriver
is not tilted during its usage. If the
driver is tilted, it could damage the
hex drive and might complicate the
extraction of the implants.

NCB Screw ∅ 5.0mm

NCB Unicortical Screw ∅ 5.0mm

1. To insert a 5.0mm NCB Screw
(REF 02.03150.xxx) use the 4.3mm
NCB Drill Guide (REF 02.00024.011)
and drill with the 4.3mm drill bit
(REF 02.00024.002).

1. To insert a 5.0mm NCB Unicortical
Screw (REF 02.03151.0xx) use
the 4.3mm NCB Drill Guide
(REF 02.00024.011) and drill with the
4.3mm drill bit (REF 02.00024.002).

In case of hard cortical bone or the
presence of a cement mantle, tap the
­cortex with the 5.0mm NCB Tap
(REF 02.00024.341). Remove the
4.3mm NCB Drill Guide before using
the NCB Tap.

In case of hard cortical bone or the
presence of cement mantle, tap the
cortex with the 5.0mm NCB Tap
(REF 02.00024.341). Remove the
4.3mm NCB Drill Guide before using
the NCB Tap.

Note: Inserting screws in the presence of
a cement mantle can cause cracks, which
may cause loosening of the prosthesis.
Overdrilling by using a drill bit of a
slightly larger diameter (0.2mm) may
reduce cracking in the cement mantle
during screw insertion. Instead of the
4.3mm drill bit, use the 4.5mm drill bit
(REF 02.00024.330) and its corresponding
drill guide (REF 02.00024.331).1

Note: Inserting screws in the presence of
a cement mantle can cause cracks,
which may cause loosening of the
prosthesis. Overdrilling by using a drill bit
of a slightly larger diameter (0.2mm) may
reduce cracking in the cement mantle
during screw insertion. Instead of the
4.3mm drill bit, use the 4.5mm drill bit
(REF 02.00024.330) and its corresponding
drill guide (REF 02.00024.331).1

2. Use the NCB Measuring Device
(REF 02.00024.005) to determine the
appropriate screw length and insert
the NCB Screw using the NCB Hexagonal
Screwdriver (REF 02.00024.023) or
screwdriver shaft (REF 02.00024.024).

2. Use the NCB Measuring Device
(REF 02.00024.005) to determine the
appropriate screw length and
insert the NCB Unicortical Screw using
the NCB Hexagonal Screwdriver
(REF 02.00024.023).

3. To lock the construct, insert the NCB
Locking Caps (REF 02.03150.300) as
described at the beginning of this section.

Note: When using the NCB Measuring
Device to measure the length of the NCB
Unicortical Screw needed, the device will
not hook the far cortex of the bone. Use
the screw length measured. Do not use a
longer screw.

Note: If using the NCB Straight Narrow
Shaft Plate for humerus shaft fractures
the use of NCB Torque Limiting Screwdriver 4Nm (REF 02.00024.022) is also
acceptable.
• In case of periprosthetic fractures do
not hit the prosthesis with the tip of the
drill, tap or screw.

1

J. Kampshoff et al.: The treatment of periprosthetic fractures with locking plates:
effect of drill and screw type on cement mantles: a biomechanical analysis,
Archives of Orthopedic and Trauma Surgery, Springer, March 2009.

3. To lock the construct, insert the NCB
Locking Caps (REF 02.03150.300) as
described at the beginning of this section.

NCB® Large Fragment System – Surgical Technique

NCB Screw ∅ 4.0mm

1. To insert a 4.0mm NCB Screw
(REF 02.03155.0xx) use the 3.3mm
NCB Drill Guide (REF 02.00024.111)
and drill with the 3.3mm drill bit
(REF 02.00024.118).
In case of hard cortical bone or the
presence of the cement mantle, tap the
cortex with the 4.0mm NCB Tap
(REF 02.00024.340). Remove the 3.3mm
NCB Drill Guide before using the NCB Tap.
Note: Inserting screws in the presence
of a cement mantle can cause cracks,
which may cause loosening of the prosthesis. Overdrilling by using a drill bit
of a slightly larger diameter (0.2mm) may
reduce cracking in the cement mantle
during screw insertion. Instead of the
3.3mm drill bit, use the 3.5mm drill bit
(REF 02.00024.325) and its corresponding
drill guide (REF 02.00024.326).1
2. Use the NCB Measuring Device
(REF 02.00024.005) to determine the
appropriate screw length and insert
the NCB Screw using the NCB Hexagonal
Screwdriver (REF 02.00024.023) or
screwdriver shaft (REF 02.00024.024).
3. To lock the construct, insert the NCB
Locking Caps (REF 02.03150.300) as
described at the beginning of this section.

1

J. Kampshoff et al.: The treatment of periprosthetic fractures with locking plates:
effect of drill and screw type on cement mantles: a biomechanical analysis,
Archives of Orthopedic and Trauma Surgery, Springer, March 2009.

13

14

NCB® Large Fragment System – Surgical Technique

NCB Curved Femur Shaft Plate – Surgical Technique

Preoperative Planning and
Patient Positioning
Preoperative Planning
Preoperative planning with adequate
x-rays and x-ray templates for
the NCB Curved Femur Shaft Plate
(Lit 06.02026.000) is strongly
recommended.

Patient Positioning
Lay the patient in the lateral position
or the supine position on a radiolucent
table. Support the knee, but allow the
leg to move freely. Perform the reduction
as necessary.

This allows determination of the proper
plate length, and the appropriate type
and position of screws, particularly in
the presence of prosthesis to prevent any
interference with the stem.

35 cm

5 cm

NCB Scre
w Poly
axiality

10 cm

30°

15 cm

NCB Scre
w
30 cm

14 hole
s

5 mm

12 hole
s

10 hole
s

25 cm

20 cm

Determine which prosthesis has been
implanted by studying the x-rays, or using
the previous surgeon’s operative notes to
be prepared in case of revision, and
assess the stability of the prosthesis. If
the prosthesis is loose, the surgical plan
may change to include revision.

15 cm

10 cm

5 cm

10 hole
s

12 hole
s

Magnific
1.15:1 ation
NCB ®
Lit. No.

Curved
Fem
26.000

060202

– Ed.

60001/

5/2010

$10050

WL

1E10K

14 hole
s

5 cm

ur Shaf

06.020

+H844

t Plate

10 cm
© 2010.
All rights
Zimme
reserve
r GmbH,
Switzer
CH-840 d.
land
4 Wintert

15 cm
hur,

0086

Patient in the lateral position

If intra-op fluoro is to be used, ensure
the fluoro machine is not blocked by
radioopaque bars of the operating table.

Patient in the supine position

15

NCB® Large Fragment System – Surgical Technique

Incision and Intra-operative
Planning

Incision

Incision
Make the incision using the lateral
subvastus approach or incorporate the
existing incision, if applicable.
Avoid excessive stripping of the soft
tissues and keep the periosteum intact.

Exessive stripping of the
soft tissue avoided and
periosteum kept intact

Intra-operative Planning
Take complete x-rays of the femur in the
A/P and lateral view and if necessary,
also in the contra-lateral view, or a CT if
osteolysis is present to determine the
length of the prosthesis, as well as the
correct plate length to be implanted.
If desired, the NCB Curved Femur Shaft
Plate Provisional (REF 02.00024.358)
can be used to determine the suitable
implant length. Provisional is semi
­radiolucent and intended to be used in
the open technique.
Warning:
Do not implant or bend the provisional.
There is only one provisional which
­represents the 12 hole NCB Curved Femur
Shaft Plate. To use the provisional for the
next shorter implant size (10 hole plate),
two square holes are included:
– the proximal square hole indicates the
most proximal NCB Plate hole of the
next shorter implant size
– the distal square hole indicates the
most distal NCB Plate hole of the next
shorter implant size.

NCB Curved Femur Shaft
Plate Provisional used for
intra-operative planning
(optional)
10 hole plate

Provisional

12 hole plate

Next shorter
implant size

Last NCB Plate hole

Square holes are included
to indicate the next
shorter implant size

Last NCB Plate hole

16

NCB® Large Fragment System – Surgical Technique

Reduction and Preliminary
Fixation
Reduce the fracture prior to inserting the
plate. Bone fragments may be secured with
2.0mm k-wires (REF 290.20.280) or clamps
such as pointed reduction forceps. Make
sure that preliminary fixation devices do
not interfere with the future location of the
plate and screws, or with the prosthesis.

Insertion of the NCB Curved Femur
Shaft Plate
The following example shows a case
without a prosthesis in-situ.

NCB Curved Femur Shaft Plate
centered over the fracture
and temporarily fixed with two
2.0mm k-wires

The NCB Curved Femur Shaft Plate is
placed on the lateral femur centered over
the fracture.
Temporarily fix the plate with two 2.0mm
k-wires (REF 290.20.280), one proximally
and one distally.
Compression guide placed so
that the drill hole is at the
end of the compression slots
farthest from the fracture site.

Note:
The NCB Curved Femur Shaft Plate is
anatomically shaped.
If additional contouring is
required, use the Bending Press
Inserts (REF 02.00024.315/6) and the
­corresponding Bending Press
(REF 100.06.010).
Be aware that bending the plate may
decrease its fatigue strength.
Furthermore, the locking mechanism of
the NCB Screw hole may be damaged
and, therefore, may no longer function.
Do not use a hole that has been altered
by contouring for locking.

Correct orientation of the
concave Bending Press
insert: with the word “TOP”
etched on the top of the
insert

17

NCB® Large Fragment System – Surgical Technique

Insertion of the NCB Screws
The NCB Curved Femur Shaft Plate has two
compression slots to allow for axial
adjustment while positioning the plate,
as well as for axial compression.
Note: It is possible to get 1 or 2mm of
axial compression with the NCB Curved
Femur Shaft Plate. For 2mm of compression, insert the NCB Screws into the compression holes first (like in the example
shown in this surgical technique).
For 1mm of compression, insert a NCB
Screw into a NCB Plate hole, and then use
the compression slot on the opposite side
of the fracture. If more compression is
needed, use the Articulated Tension Device
(REF 00-4817-005-00) after only one side
of the plate has been fixed. This instrument
can be attached to the bone, using a
4.0mm NCB Screw.
For screw selection and insertion, please
refer to pages 12–13.
Note: Screws should not be locked until
both sides of the fragment have been
fixed.
1. For 2.0mm of axial compression, drill
the first hole in one of the two compression slots in the compression position
using the NCB Compression Drill Guide for
5.0mm NCB Screws (REF 02.00024.335)
and the 4.3mm drill bit (REF 02.00024.002).
Place the compression guide so that the
drill hole is at the end of the compression
slots farthest from the fracture site.
­Partially insert a 5.0mm NCB Screw into
the ­compression slot but do not tighten it.

First 5.0mm NCB Screw
partially inserted in one of
the two compression
slots without tightening it
Second 5.0mm NCB Screw
partially inserted in the
other compression slot without tightening it, and k-wires
removed

18

NCB® Large Fragment System – Surgical Technique

2. Partially insert a 5.0mm NCB Screw into
the other compression slot, also in the
compression position, but do not tighten it.

K-wires removed and axial
compression achieved
by tightening the 5.0mm
NCB Screws in the two compression slots

3. Remove the two 2.0mm k-wires.
To achieve axial compression, tighten the
NCB Screws in the two compression slots
by using the NCB Hexagonal Screwdriver
(REF 02.00024.023).

4. Insert additional 5.0mm NCB Screws
as necessary, first near the fracture site
and then proximal/distal to the fracture,
ensuring purchase in a minimum of six
cortices on each side of the fracture,
spaced on the entire length of the plate.
If desired, slightly loosen the 5.0mm NCB
Screws in the two compression slots to
avoid contact between the plate and the
bone.

Additional 5.0mm NCB
Screws inserted as necessary
first near the fracture site
and then proximal/distal to
the fracture, ensuring
purchase in a minimum of
six cortices with the screws
on each side of the fracture
spaced on the entire length
of the plate

19

NCB® Large Fragment System – Surgical Technique

NCB Straight Narrow Shaft Plate – Surgical Technique

Preoperative Planning and
Patient Positioning
Preoperative Planning
Preoperative planning with adequate
x-rays and x-ray templates for
the NCB Straight Narrow Shaft Plate
(Lit 06.02263.000) is strongly
recommended.

Patient Positioning
Tibia – Lay the patient in the supine
­position on a radiolucent table. Support
the knee, but allow the leg to move freely.
Perform the reduction as necessary.

This allows determination of the proper
plate length, and the appropriate type
and position of screws, particularly in the
presence of prosthesis to prevent any
interference with the stem.
In periprosthetic fractures determine
which prosthesis has been implanted by
studying the x-rays, or using the previous
surgeon’s operative notes to be prepared
in case of revision, and assess the stability of the prosthesis. If the prosthesis is
loose, the surgical plan may change to
include revision.

Patient in the beachchair position

Humerus – The patient is placed on the
operating table in the beachchair position or supine position. After the patient
is in the correct position, the C-arm must
be adjusted so as to achieve the widest
possible view of the humerus.
If intra-op fluoro is to be used, ensure the
fluoro machine is not blocked by radioopaque bars of the operating table.
Patient in the supine position

20

NCB® Large Fragment System – Surgical Technique

Incision and Intra-operative
Planning
Incision
Tibia: The anterior approach is the standard approach to the tibia, located 1cm
lateral to its anterior crest. Take care not
to compromise the great saphenous vein
and nerve.
Humerus: Plating of humeral shaft fractures may be performed through the
anterolateral approach.
Intra-operative Planning
Take complete x-rays of the tibia or the
humerus respectively in the A/P and lateral view and if necessary, also in the
contra-lateral view, or a CT if osteolysis is
present to determine the length of the
prosthesis, as well as the correct plate
length to be implanted.
If desired, the NCB Straight Narrow Shaft
Plate Provisionals (REF 02.00024.401 / REF
02.00024.402) can be used to determine
the suitable implant length. Provisionals
are semi radiolucent and intended to be
used in the open technique.

Square holes are included
to indicate the next shorter
implant size.

NCB Straight Narrow Shaft Plate Provisional
used for intraoperative planning.

Warning:
Do not implant or bend the provisional.
Each provisional represents the implant
sizes it is labeled for, e.g. 10 or 16 holes.
To use the provisional for the next shorter
implant size (e.g. 8 or 14 hole plate), a
square hole is included:
– the square hole indicates the last
NCB hole of the next shorter implant
size.

Last NCB Plate hole

	
8 holes	
10 holes	
		 Provisional

10 holes

21

NCB® Large Fragment System – Surgical Technique

Reduction and Preliminary
Fixation
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. Make sure that preliminary fixation
devices do not interfere with the future
location of the plate and screws, or with
the prosthesis.

Insertion of the NCB Straight
Narrow Shaft Plate

NCB Straight Narrow Shaft
Plate centered over the
­fracture and temporarily fixed
with two 2.0mm k-wires

The following example shows a tibia case
without a prosthesis in-situ. All steps are
also applicable for humerus shaft fractures.
The NCB Straight Narrow Shaft Plate is
placed on the medial tibia or lateral
humerus ­centered over the fracture.
Temporarily fix the plate with two 2.0mm
k-wires (REF 290.20.280), one proximally
and one distally.

Note:
If contouring is required, use the Bending
Press Inserts (REF 02.00024.315/6) and
the ­corresponding Bending Press
(REF 100.06.010).
Alternatively, the large bending iron
(REF 02.00000.003) can be used as well.
Be aware that bending the plate may
decrease its fatigue strength.
Furthermore, the locking mechanism of
the NCB Screw hole may be damaged
and, therefore, may no longer function.
Do not use a hole that has been altered
by contouring for locking.

Compression guide placed so
that the drill hole is at the
end of the compression slots
farthest from the fracture site.

Correct orientation of the
concave Bending Press
insert: with the word “TOP”
etched on the top of the
insert

22

NCB® Large Fragment System – Surgical Technique

Insertion of the NCB Screws
The NCB Straight Narrow Shaft Plate has
two compression slots to allow for axial
adjustment while positioning the plate, as
well as for axial compression.
Note: If using the compression slots insertion of 4mm NCB Screws is required.
Note: It is possible to get 1 or 2mm of
axial compression with the NCB Straight
Narrow Shaft Plate. For 2mm of compression, insert the NCB Screws into the compression holes first (like in the example
shown in this surgical technique). For
1mm of compression, insert a NCB Screw
into a NCB Plate hole, and then use the
compression slot on the opposite side
of the fracture.
For screw selection and insertion, please
refer to pages 12–13.
Note: Screws should not be locked until
both sides of the fragment have been
fixed.
1. For 2.0mm of axial compression, drill the
first hole in one of the two compression
slots in the compression position
using the NCB Compression Drill Guide for
4.0mm NCB Screws (REF 02.00024.336)
and the 3.3mm drill bit (REF 02.00024.002).
Place the compression guide so that the
drill hole is at the end of the compression
slots farthest from the fracture site. Partially insert a 4.0mm NCB Screw into the compression slot but do not tighten it.

First 4.0mm NCB Screw
partially inserted in one of
the two compression
slots without tightening it

Second 4.0mm NCB Screw
partially inserted in the
other compression slot without tightening it, and k-wires
removed

23

NCB® Large Fragment System – Surgical Technique

2. Partially insert a 4.0mm NCB Screw into
the other compression slot, also in the
compression position, but do not tighten it.

3. Remove the two 2.0mm k-wires. To
achieve axial compression, tighten the
NCB Screws in the two compression slots
by using the NCB Hexagonal Screwdriver
(REF 02.00024.023).

K-wires removed and axial
compression achieved
by tightening the 4.0mm
NCB Screws in the two compression slots

4. Insert additional 4.0mm NCB Screws as
necessary, first near the fracture site and
then proximal/distal to the fracture, ensuring purchase in a minimum of six cortices
on each side of the fracture, spaced on
the entire length of the plate.
If desired, slightly loosen the 4.0mm NCB
Screws in the two compression slots to
avoid contact between the plate and the
bone.

Additional 4.0mm NCB
Screws inserted as necessary
first near the fracture site
and then proximal/distal to
the fracture, ensuring
purchase in a minimum of
six cortices with the screws
on each side of the fracture
spaced on the entire length
of the plate

24

NCB® Large Fragment System – Surgical Technique

Tips and Tricks for the NCB Large Fragment System used in periprosthetic fractures

Drilling into Cement Mantle

Drilling into Cortical Bone

Metal Abrasion Wear

In patients with cemented prostheses,
the insertion of screws may occur in the
presence of a cement mantle. This can
cause cracks, which may cause loosening
of the prosthesis. Be careful not to hit
the prosthesis when tapping, drilling and
inserting screws.

In order to go around the stem of the
prosthesis and achieve bicortical
fixation, it may be necessary to drill
completely into cortical bone, which can
lead to heat necrosis of the bone.

Metal abrasion wear due to contact
between screws, plates, prostheses,
cable buttons, and cables may occur.

Tips, which may Mitigate this Risk
• Use a lower speed for drilling into the
cement mantle to prevent overheating
and avoid cement melting
•	Use a higher feed rate (increased drill
force)
•	Use only new sharp drill bits. Change
drills frequently and do not use worn
ones
•	Titanium nitride coated (gold) drill bits
are available:
	 • 3.5mm drill bit (REF 02.00024.325)
	 • 4.5mm drill bit (REF 02.00024.330)
• Use taps
•	Overdrilling by using drill bits of a
slightly larger diameter (0.2mm) may
reduce cracking in the cement mantle
during screw insertion. In the NCB
Large Fragment set a 3.5mm drill bit
(REF 02.00024.325) can be used in
place of the 3.3mm drill bit, and a
4.5mm drill bit (REF 02.00024.330) can
be used in place of the 4.3mm drill bit.
These drill bits are available together
with their corresponding drill guides.

Warning: Drilling and inserting screws
into the outer edge of the cortical bone
may also lead to cortical fracture.
Tips, which may Mitigate these Risks
• Use only new sharp drill bits. Change
drills frequently and do not use worn
ones
• Pull the drill bit out often and
clean its flutes
• Use extensive irrigating fluid (i.e.
saline water) directed at the point of
penetration of the cortex
• Use taps
• In case of thin bone cortex, away from
the fracture area, use NCB screws
of a smaller diameter like the 4.0mm
NCB Screws.
	

Note: Overdrilling the cement mantle by
0.2mm does reduce pull out strength
by about 20%. However, within the
cement mantle pull out strength is still
more than 2000 N.1

1	

J. Kampshoff et al.: The treatment of periprosthetic fractures with locking
plates: effect of drill and screw type on cement mantles: a biomechanical
analysis, Archives of Orthopedic and Trauma Surgery, Springer, March 2009.

Tip, which may Mitigate this Risk
Use only Zimmer products compatible
with the NCB Large Fragment System,
which are described in this
surgical technique.
	

NCB® Large Fragment System – Surgical Technique

Post-Operative Treatment

Implant Removal

Post-operative treatment with locking
plates does not differ from conventional
internal fixation procedures. If there is
concern about stability, consider using
additional external fixation devices and/
or a cast/brace. Early range of motion
exercises of the involved joints may also
be beneficial. However, it is the respon­
sibility of the surgeon to determine
the most suitable post-operative care
depending on each patient’s health condition.

To remove the NCB Large Fragment
Plates, first remove all locking caps
(REF 02.03150.300). Then, loosen all the
NCB Screws without completely removing
them (this prevents rotation of the
bone plate when removing the last
screw). Finally, completely remove all
NCB Screws.
Note: Make sure that the tip of the
NCB Hexagonal Screwdriver
(REF 02.00024.023) is correctly placed
in the hex drive of the locking caps and/
or NCB Screws. Failure to do so could
damage the hex drive and complicate the
extraction of the implant.
Removal Tip
In case of difficulties while loosening the
NCB Screws, tighten the screws slightly
before loosening them.

25

26

NCB® Large Fragment System – Surgical Technique

Product Information – Implants
Plates

NCB Curved Femur Shaft Plates
REF	

REF Sterile	

02.03265.010	 02.02265.010	
02.03265.012	 02.02265.012	
02.03265.014	 02.02265.014	

Holes	

Length mm

10	
12	
14	

210
249
289

NCB Straight Narrow Shaft Plate
REF	

REF Sterile	

Holes	

Length mm

02.03267.008	
02.03267.010	
02.03267.012	
02.03267.014	
02.03267.016	
02.03267.018	

02.02267.008	
02.02267.010	
02.02267.012	
02.02267.014	
02.02267.016	
02.02267.018	

8	
10	
12	
14	
16	
18	

118
146
174
202
230
258

Materials
NCB® Periprosthetic Plates and Screws are made of titanium alloy TiAlV,
Protasul®-64, ISO 5832-3, ASTM F136

27

NCB® Large Fragment System – Surgical Technique

Screws*
NCB Locking Caps, Spacers, Blind Screw Inserts
REF	

REF Sterile	

Description

02.03150.300	
02.03150.310	
02.03150.311	
02.03150.312	
02.03150.313	

02.02150.300	
02.02150.310	
02.02150.311	
02.02150.312	
02.02150.313	

Locking cap
Blind screw insert
Spacer 1mm
Spacer 2mm
Spacer 3mm

NCB Screws, ∅ 5.0mm
∅5

∅ 4.4

∅ 6.2

NCB Unicortical Screws, ∅ 5.0mm
∅ 4.4 ∅ 5 ∅ 6.2

1.75

L

REF	

REF Sterile	

Length mm

02.03151.010	02.02151.010	10
02.03151.012	02.02151.012	12
02.03151.014	02.02151.014	14
02.03151.016	 02.02151.016	 16
02.03151.018	02.02151.018	18
02.03151.020	02.02151.020	20

1.75

L

REF	

REF Sterile	

NCB Screws, ∅ 4.0mm
Length mm

02.03150.022	02.02150.022	
02.03150.024	02.02150.024	
02.03150.026	 02.02150.026	
02.03150.028	02.02150.028	
02.03150.030	02.02150.030	
02.03150.032	02.02150.032	
02.03150.034	02.02150.034	
02.03150.036	 02.02150.036	
02.03150.038	02.02150.038	
02.03150.040	02.02150.040	
02.03150.042	02.02150.042	
02.03150.044	02.02150.044	
02.03150.046	 02.02150.046	
02.03150.048	02.02150.048	
02.03150.050	02.02150.050	
02.03150.055	02.02150.055	
02.03150.060	 02.02150.060	
02.03150.065	 02.02150.065	
02.03150.070	02.02150.070	
02.03150.075	02.02150.075	
02.03150.080	02.02150.080	
02.03150.085	02.02150.085	

22
24
26
28
30
32
34
36
38
40
42
44
46
48
50
55
60
65
70
75
80
85

∅ 3.4

∅4

1.75

L

REF	

*C
 ompatible screw scope, may vary from screw scope in existing
NCB Instrument sets.

REF Sterile	

Length mm

02.03155.020	02.02155.020	
02.03155.022	02.02155.022	
02.03155.024	02.02155.024	
02.03155.026	 02.02155.026	
02.03155.028	02.02155.028	
02.03155.030	02.02155.030	
02.03155.032	02.02155.032	
02.03155.034	02.02155.034	
02.03155.036	 02.02155.036	
02.03155.038	02.02155.038	
02.03155.040	02.02155.040	
02.03155.042	02.02155.042	
02.03155.044	02.02155.044	
02.03155.046	 02.02155.046	
02.03155.048	02.02155.048	
02.03155.050	02.02155.050	
02.03155.055	02.02155.055	
02.03155.060	 02.02155.060	
02.03155.065	 02.02155.065	
02.03155.070	02.02155.070	
		

Materials
NCB® Periprosthetic Plates and Screws are made of titanium alloy TiAlV,
Protasul®-64, ISO 5832-3, ASTM F136

∅ 6.2

20
22
24
26
28
30
32
34
36
38
40
42
44
46
48
50
55
60
65
70

28

NCB® Large Fragment System – Surgical Technique

Cortical Screws, ∅ 3.5mm
∅ 2.4

∅ 3.5

Cortical Screws, ∅ 3.5mm (EMEA only)

∅ 5.9

∅ 2.4

1.25

∅ 3.5

∅ 5.9

1.25
L

REF	

L

REF Sterile	

Length mm

00-4935-020-01	47-4935-020-01	
00-4935-022-01	47-4935-022-01	
00-4935-024-01	47-4935-024-01	
00-4935-026-01	 47-4935-026-01	
00-4935-028-01	47-4935-028-01	
00-4935-030-01	47-4935-030-01	
00-4935-032-01	47-4935-032-01	
00-4935-034-01	47-4935-034-01	
00-4935-036-01	 47-4935-036-01	
00-4935-038-01	47-4935-038-01	
00-4935-040-01	47-4935-040-01	

20
22
24
26
28
30
32
34
36
38
40

REF	

REF Sterile	

02.03131.020	–	
02.03131.022	–	
02.03131.024	–	
02.03131.026	
–	
02.03131.028	–	
02.03131.030	–	
02.03131.032	–	
02.03131.034	–	
02.03131.036	
–	
02.03131.038	–	
02.03131.040	–	

Length mm

20
22
24
26
28
30
32
34
36
38
40

Compatible Zimmer Products with the NCB Large Fragment System
REF sterile	

Description

47-2232-060-01	
00-2232-002-35	
00-2232-002-28	
00-2232-004-18	

NCB Polyaxial Locking Plate Cable Button, 2.5mm Hex Drive, Material: Ti-6Al-4V (Tivanium® Alloy)
Hex Buttons, 3.5mm Hex, Material: C.P. Titanium
Cable-Ready Cable Assembly Cerclage, ∅ 1.8mm, L. 914mm, Material: CoCr
Cable-Ready Cable Assembly Cerclage, ∅ 1.8mm, L. 635mm, Material: CoCr

29

NCB® Large Fragment System – Surgical Technique

Product Information – Instruments
The NCB Straight Narrow Shaft plate and the NCB Curved Femur Shaft plate can be implanted using the following existing
instrument sets.
NCB Straight Narrow Shaft Plate
Anatomical Location
Systems Available

Humeral

NCB Curved Femur Shaft Plate

Tibial

Femoral

• NCB Proximal Humerus System

• NCB Proximal Tibial System

• NCB Distal Femur System

• NCB Periprosthetic
Femur Plate System

• NCB Periprosthetic
Femur Plate System

• NCB Periprosthetic
Femur Plate System

If using non-sterile plates the NCB Shaft Plate Add-On Set needs to be provided as well. Outside lag screw instrumentation can
also be found in the NCB Shaft Plate Add-On Set if needed.

Screw availability in NCB Instrument Sets
NCB Proximal
Humerus System

NCB Proximal Tibia
System

NCB Distal Femur
System

NCB Periprosthetic
Femur System

NCB Shaft Plate
Add-On Set

∅ 4.0mm NCB Screws,
14–65mm length

∅ 4.0mm NCB Screws,
14–90mm length

∅ 5.0mm NCB Screws,
14–85mm length

∅ 4.0mm NCB Screws,
20–65mm length

∅ 3.5mm Cortical
(for lagging outside
plate only,
50–85mm length)

∅ 5.0mm NCB Screws,
22–100mm length

∅ 3.5mm Cortical
(for lagging outside
plate only,
20–40mm length)

∅ 5.0mm unicortical
NCB Screws,
10–20mm length

NCB Shaft Plate Add-On Set
REF sterile	

Description

00-4806-110-25	
00-4806-110-35	
00-4808-035-01	
00-4809-035-00	
00-4810-002-01	
00-4811-110-35	
00-4812-000-00	
00-4812-035-00	
00-2360-165-25	
00-4812-035-05	
02.00024.336	
02.00024.360	
02.00024.361	

Drill Bit, Q/C, 2.5mm Dia, 110mm
Drill Bit, Q/C, 3.5mm Dia, 110mm
3.5mm/2.5mm Double Drill Sleeve
Countersink, Q/C, for 3.5mm and 4.0mm screws
Small Depth Gauge
3.5mm Tap (2.5 Core Diameter)
Self-holding screw forceps
Small Hex Screwdriver, 2.5mm Hex
Small Hex Screwdriver Shaft, with Q/C, 2.5mm Hex, 140mm
Small Holding Sleeve for Small Hex Screwdriver
NCB Compression Drill Guide 4.0mm Screws
NCB Drill Bit ∅ 4.0mm, with quick coupling, L. 245mm
NCB Drill Guide ∅ 4.0mm, long

Optional Instruments
NCB Provisionals
REF	Description

02.00024.358	
02.00024.401	
02.00024.402	

NCB Curved Femur Shaft Plate Provisional, 10/12/14 hole plates
NCB Straight Narrow Shaft Plate Provisional, 8/10/12 hole plates
NCB Straight Narrow Shaft Plate Provisional, 14/16/18 hole plates

30

NCB® Large Fragment System – Surgical Technique

Additional Instruments
NCB Long Instruments
REF	Description

02.00024.340	
02.00024.341	
02.00024.344	
02.00024.345	
02.00024.346	
02.00024.347	

NCB Tap ∅ 4.0mm, with quick coupling, L. 250mm
NCB Tap ∅ 5.0mm, with quick coupling, L. 250mm
NCB Drill Bit ∅ 3.3mm, with quick coupling, L. 245mm
NCB Drill Guide ∅ 3.3mm, long
NCB Drill Bit ∅ 4.3mm, with quick coupling, L. 245mm
NCB Drill Guide ∅ 4.3mm, long

NCB Instruments for Overdrilling into Cement for NCB Screws ∅ 4.0mm and 5.0mm
REF	Description

02.00024.325	
02.00024.326	
02.00024.330	
02.00024.331	

NCB Drill Bit ∅ 3.5mm, with quick coupling, L. 195mm
NCB Drill Guide ∅ 3.5mm
NCB Drill Bit ∅ 4.5mm, with quick coupling, L. 195mm
NCB Drill Guide ∅ 4.5mm

NCB Compression Drill Guides
REF	Description

02.00024.335	

NCB Compression Drill Guide for ∅ 5.0mm screws

Sterile Instruments
REF	Description

02.02024.344	
NCB Drill Bit ∅ 3.3mm, with quick coupling, L=245mm
02.02024.346	
NCB Drill Bit ∅ 4.3mm, with quick coupling, L=245mm
02.02024.360	
NCB Drill Bit ∅ 4.0mm, with quick coupling, L=245mm
		

Graphic Cases for the NCB Shaft Plate Add-On Set
REF	Description

00-5900-099-00	
02.00024.930	
02.00024.931	
02.00024.932	
02.00024.933	
02.00024.934	

Generic Stackable Lid Assembly
NCB Shaft Plate Add-On Set
NCB Shaft Plate Add-On Set – Base
NCB Shaft Plate Add-On Set – Screw Caddy
NCB Shaft Plate Add-On Set – Top Tray
NCB Shaft Plate Add-On Set – Bottom Tray

31

NCB® Large Fragment System – Surgical Technique

Planning Aid

NCB Curved Femur Shaft Plate X-ray Template
Lit.No. 06.02026.000
Lit.No. 97-2370-050-03

	

(US only)

NCB Straight Narrow Shaft Plate X-ray Template
Lit.No. 06.02263.000
Lit.No. 97-2370-007-00 (US only)

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

Lit.No. 06.02256.012 – Ed. 2012-10 ZHUB

Copyright 2012 by Zimmer GmbH Printed in Switzerland Subject to change without notice

Disclaimer



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Derived From Rendition Class    : default
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History Instance ID             : xmp.iid:70FA2474072068118C14D33A540B27AE, xmp.iid:71FA2474072068118C14D33A540B27AE, xmp.iid:F333545D092068118C14D33A540B27AE, xmp.iid:B8BEB16B092068118C14D33A540B27AE, xmp.iid:C7539AA9092068118C14D33A540B27AE, xmp.iid:F17485BC092068118C14D33A540B27AE, xmp.iid:147522310B2068118C14D33A540B27AE, xmp.iid:291C28FA0B2068118C14D33A540B27AE, xmp.iid:C063E6060C2068118C14D33A540B27AE, xmp.iid:C163E6060C2068118C14D33A540B27AE, xmp.iid:C263E6060C2068118C14D33A540B27AE, xmp.iid:5CCC5AB70C2068118C14D33A540B27AE, xmp.iid:FA0C92010E2068118C14D33A540B27AE, xmp.iid:B88D03020F2068118C14D33A540B27AE, xmp.iid:1350D61E0F2068118C14D33A540B27AE, xmp.iid:1450D61E0F2068118C14D33A540B27AE, xmp.iid:55EE2FEB162068118C14D33A540B27AE, xmp.iid:BB7779B7172068118C14D33A540B27AE, xmp.iid:BC7779B7172068118C14D33A540B27AE, xmp.iid:83615FA5182068118C14D33A540B27AE, xmp.iid:292F7BA2262068118C14D33A540B27AE, xmp.iid:21B6831B272068118C14D33A540B27AE, xmp.iid:E28BEA31272068118C14D33A540B27AE, xmp.iid:E38BEA31272068118C14D33A540B27AE, xmp.iid:F440C139282068118C14D33A540B27AE, xmp.iid:A4FCCF60282068118C14D33A540B27AE, xmp.iid:11B779CB282068118C14D33A540B27AE, xmp.iid:E544E9EB282068118C14D33A540B27AE, xmp.iid:0BAEFC6E292068118C14D33A540B27AE, xmp.iid:0CAEFC6E292068118C14D33A540B27AE, xmp.iid:865FD4AF292068118C14D33A540B27AE, xmp.iid:5C253EE9292068118C14D33A540B27AE, xmp.iid:6AC9C0892A2068118C14D33A540B27AE, xmp.iid:2BB0AEAC2A2068118C14D33A540B27AE, xmp.iid:412DF9F42A2068118C14D33A540B27AE, xmp.iid:F13F1D072B2068118C14D33A540B27AE, xmp.iid:F23F1D072B2068118C14D33A540B27AE, xmp.iid:DEE0D2302B2068118C14D33A540B27AE, xmp.iid:DFE0D2302B2068118C14D33A540B27AE, xmp.iid:257DC5AD2C2068118C14D33A540B27AE, xmp.iid:12BB7E69422068118C14D33A540B27AE, xmp.iid:1C3C5C72422068118C14D33A540B27AE, xmp.iid:753748FD432068118C14D33A540B27AE, xmp.iid:5C2EEB20442068118C14D33A540B27AE, xmp.iid:D11FCF35172068118A6DE9D2A1D62E60, xmp.iid:787FEA7B172068118A6DE9D2A1D62E60, 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xmp.iid:B8A5D435172068118083E76D6043A8A0, xmp.iid:8D099E4B172068118083E76D6043A8A0, xmp.iid:DB71B5D74B2068118C14B8DF2BD0AEC1, xmp.iid:8F01E8900E2068118083997C04784AF7, xmp.iid:7E96714C172068118083997C04784AF7, xmp.iid:AF84C445192068118083997C04784AF7, xmp.iid:5973DC821A2068118083997C04784AF7, xmp.iid:35611ABA1B2068118083997C04784AF7, xmp.iid:6562D46F1D2068118083997C04784AF7, xmp.iid:0F1F9BB61E2068118083997C04784AF7, xmp.iid:290342541F2068118083997C04784AF7, xmp.iid:738F6501202068118083997C04784AF7, xmp.iid:74B47576202068118083997C04784AF7, xmp.iid:4D1DEA6A322068118083997C04784AF7, xmp.iid:4E87431A342068118083997C04784AF7, xmp.iid:C81DF4B3342068118083997C04784AF7, xmp.iid:77D351270B2068118C14E2AF96483F16, xmp.iid:2C27FA6D102068118C14E2AF96483F16, xmp.iid:66EA01CE1420681188C6C0F848EE1220, xmp.iid:77DD02E21420681188C6C0F848EE1220, xmp.iid:FD0584AD0A2068118083F47B890F03B8, xmp.iid:8EBAC4D10A2068118083F47B890F03B8, xmp.iid:5A93A7040B2068118083F47B890F03B8, xmp.iid:37C8382F0B2068118083F47B890F03B8, xmp.iid:38C8382F0B2068118083F47B890F03B8, xmp.iid:5E8F628C0B2068118083F47B890F03B8, xmp.iid:36EBD7A80B2068118083F47B890F03B8, xmp.iid:14E1BF280C2068118083F47B890F03B8, xmp.iid:DA6C96410C2068118083F47B890F03B8, xmp.iid:52CDD9840C2068118083F47B890F03B8, xmp.iid:F8D69AAF0C2068118083F47B890F03B8, xmp.iid:8161F7CB0C2068118083F47B890F03B8, xmp.iid:8261F7CB0C2068118083F47B890F03B8, xmp.iid:510F67750D2068118083F47B890F03B8, xmp.iid:1356319D0E2068118083F47B890F03B8, xmp.iid:5CE467E40E2068118083F47B890F03B8, xmp.iid:A2EB091B0F2068118083F47B890F03B8, xmp.iid:292BC8350F2068118083F47B890F03B8, xmp.iid:2EBEF2D00F2068118083F47B890F03B8, xmp.iid:AAFD1674072068118083B9D53F899C24, xmp.iid:30AD3D81072068118083B9D53F899C24, xmp.iid:31AD3D81072068118083B9D53F899C24, xmp.iid:E8CFB1FA072068118083B9D53F899C24, xmp.iid:F68B260F082068118083B9D53F899C24, xmp.iid:4C932669082068118083B9D53F899C24, xmp.iid:3BE80090082068118083B9D53F899C24, xmp.iid:825DA2D6082068118083B9D53F899C24, xmp.iid:AD7F4EF50A2068118083B9D53F899C24, xmp.iid:121661670B2068118083B9D53F899C24, xmp.iid:A33780E90B2068118083B9D53F899C24, xmp.iid:C2CD43460C2068118083B9D53F899C24, xmp.iid:20AD1D660C2068118083B9D53F899C24, xmp.iid:B61042AB0C2068118083B9D53F899C24, xmp.iid:5EC5797E0D2068118083B9D53F899C24, xmp.iid:D5C8D0EB0D2068118083B9D53F899C24, xmp.iid:D6C8D0EB0D2068118083B9D53F899C24, xmp.iid:A4705D290E2068118083B9D53F899C24, xmp.iid:A5705D290E2068118083B9D53F899C24, xmp.iid:067FE2550E2068118083B9D53F899C24, xmp.iid:C7FE1A870E2068118083B9D53F899C24, xmp.iid:00B9AAB80E2068118083B9D53F899C24, xmp.iid:0A089E9C0F2068118083B9D53F899C24, xmp.iid:0B6A1C74072068118C14BC8083D5A605, xmp.iid:3022CA451E2068118083E1744D803804, xmp.iid:5E202F821E2068118083E1744D803804, xmp.iid:5F202F821E2068118083E1744D803804, xmp.iid:8541A6231F2068118083E1744D803804, xmp.iid:F2E01F4D1F2068118083E1744D803804, xmp.iid:5EA879611F2068118083E1744D803804, 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History When                    : 2011:02:14 09:37:12+01:00, 2011:02:14 09:37:12+01:00, 2011:02:14 09:50:52+01:00, 2011:02:14 09:51:16+01:00, 2011:02:14 09:53+01:00, 2011:02:14 09:53:32+01:00, 2011:02:14 10:03:57+01:00, 2011:02:14 10:09:34+01:00, 2011:02:14 10:09:56+01:00, 2011:02:14 10:11:57+01:00, 2011:02:14 10:12:32+01:00, 2011:02:14 10:14:52+01:00, 2011:02:14 10:24:06+01:00, 2011:02:14 10:31:16+01:00, 2011:02:14 10:32:05+01:00, 2011:02:14 11:22:44+01:00, 2011:02:14 11:27:54+01:00, 2011:02:14 11:33:37+01:00, 2011:02:14 11:39:39+01:00, 2011:02:14 11:40:16+01:00, 2011:02:14 13:20:24+01:00, 2011:02:14 13:23:47+01:00, 2011:02:14 13:24:25+01:00, 2011:02:14 13:30:50+01:00, 2011:02:14 13:31:47+01:00, 2011:02:14 13:32:53+01:00, 2011:02:14 13:35:52+01:00, 2011:02:14 13:36:46+01:00, 2011:02:14 13:40:26+01:00, 2011:02:14 13:41:33+01:00, 2011:02:14 13:42:15+01:00, 2011:02:14 13:43:51+01:00, 2011:02:14 13:48:20+01:00, 2011:02:14 13:49:19+01:00, 2011:02:14 13:51:20+01:00, 2011:02:14 13:51:51+01:00, 2011:02:14 13:52:27+01:00, 2011:02:14 13:53:01+01:00, 2011:02:14 13:54:19+01:00, 2011:02:14 14:03:40+01:00, 2011:02:14 16:39:14+01:00, 2011:02:14 16:39:29+01:00, 2011:02:14 16:50:32+01:00, 2011:02:14 16:51:32+01:00, 2011:03:21 11:50:38+01:00, 2011:03:21 11:52:36+01:00, 2011:03:21 11:57:13+01:00, 2011:03:21 11:58:53+01:00, 2011:03:21 12:05:47+01:00, 2011:03:21 13:11:03+01:00, 2011:03:21 13:11:09+01:00, 2011:03:21 13:11:16+01:00, 2011:03:21 13:12:58+01:00, 2011:03:21 13:14:28+01:00, 2011:03:21 13:28:09+01:00, 2011:03:21 17:51:39+01:00, 2011:03:21 17:52:41+01:00, 2011:03:21 17:54:04+01:00, 2011:03:21 17:57:32+01:00, 2011:03:21 17:57:32+01:00, 2011:03:21 17:58:28+01:00, 2011:04:07 19:26:41+02:00, 2011:04:07 19:27:31+02:00, 2011:04:07 19:38:38+02:00, 2011:05:12 11:35:51+02:00, 2011:05:12 11:38:58+02:00, 2011:05:12 11:41:43+02:00, 2011:05:12 14:22:58+02:00, 2011:06:20 16:28:46+02:00, 2011:06:20 16:29:23+02:00, 2011:06:20 16:29:23+02:00, 2011:06:20 17:56:16+02:00, 2011:07:08 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EXIF Metadata provided by EXIF.tools

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