NCB Periprosthetic Femur Plate Surgical Technique

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NCB®

Periprosthetic

Femur

Plate System

Surgical Technique

NCB® Periprosthetic Femur System – Surgical Technique 3

Table of Contents

Introduction 4

System Features and Benefits 9

Indications and Contraindications 13

Periprosthetic Femur Fracture Classification 14

NCB Periprosthetic Plate Positioning and Screw Fixation 16

NCB Screw Insertion 20

Screw Insertion for NCB Periprosthetic Trochanter Plate 22

NCB Periprosthetic Proximal Femur Plate – Surgical Technique 23

NCB Periprosthetic Distal Femur Plate – Surgical Technique 33

NCB Curved Femur Shaft Plate – Surgical Technique 39

NCB Bone Spacers (Optional) 44

NCB Blind Screw Inserts (Optional) 44

Tips and Tricks for the NCB Periprosthetic Femur System 45

Implant Removal 46

Product Information – Implants 47

Product Information – Instruments 51

Planning Aid 54

4NCB® Periprosthetic Femur System – Surgical Technique

Introduction

The NCB (Non-Contact Bridging) Peripros-

thetic Femur System is a line of polyaxial

locking plates designed for the treatment

of femur fractures, particularly peripros-

thetic femur fractures. It consists primarily

of a Proximal Femur Plate, a Distal Femur

Plate, and a Curved Femur Shaft Plate.

NCB Periprosthetic Distal Femur Plate

NCB Periprosthetic Trochanter Plate assembled with NCB Periprosthetic Proximal Femur Plate (short)

NCB Curved Femur Shaft Plate

NCB Periprosthetic Proximal Femur Plate

In addition to that a Trochanter Plate is

available to reattach the greater tro-

chanter in combination with a Proximal

Femur Plate.

The NCB Periprosthetic Proximal and

Distal Femur Plates are wider in the

area of the prosthesis and have offset

holes that may allow bicortical screw

placement in the area of the prosthesis.

NCB® Periprosthetic Femur System – Surgical Technique 5

The labeling of the NCB Periprosthetic

Proximal and Distal Femur Plates corre-

sponds with number of NCB Plate holes in

a specific way.

Proximal Plates: the number of holes

according label text = the number of all

NCB screw holes distal to the MIS inter-

face.

Distal Plates: the number of holes

according label text = the number of all

NCB screw holes proximal to the MIS inter-

face

Example: 12 hole plate

= 2 x 3-hole pattern + 6.

The NCB Periprosthetic Trochanter Plate is

available in two different sizes (different

width) whereas the height is the same.

Due to the anatomical shape of the proxi-

mal femur a left and right version is

offered.

21 18 15 12 9 holes

+ 3

+ 3

+ 3

+ ...

MIS Interface

left wide right wideleft narrow right narrow

6NCB® Periprosthetic Femur System – Surgical Technique

NCB 30° Cone Polyaxiality Angular stability with the NCB Locking Caps

30°

Non

contact

NCB Non-Contact Bridging

Blind screw insert

Locking cap ∅ 8mm

Spacer 1 to 3mm

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 Periprosthetic

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 inser-

tion.

NCB® Periprosthetic Femur System – Surgical Technique 7

The NCB Periprosthetic Trochanter Plate

has a built in screw technology which

gives surgeons the ability to create a

fixed-angle construct while using familiar

plating techniques. The locking screw

heads contain male threads, while the

holes in the plates contain female

threads. This allows the screw head to be

threaded into the plate hole, locking the

screw into the plate. The heads are

designed to create a nearly flush profile

on the plate, which helps to decrease

soft tissue irritation.

The plate also allows anatomical reduc-

tion of the fracture fragments using stan-

dard cortical screws (non-locking).

NOTE: If lag screw fixation is necessary

for any fragment, the lag screw must be

inserted before inserting locking screws

into that fragment.

The NCB Periprosthetic Trochanter Plate

contains different hole types.

a) Hex Button holes: used to place Hex

Buttons in combination with cables

around the plate and the femoral bone.

b) Clearance holes for K-Wires: used for

preliminary fixation of the plates to the

bone.

c) Connection Screw holes: used to

assemble the NCB Periprosthetic

Trochanter Plate to the NCB Periprosthetic

Proximal Femur Plate. Screws must be

tightened to 6Nm using the correspond-

ing torque screwdriver (REF 02.00024.021).

Double-lead threads

(Double the shaft

thread pitch)

Shallow thread

profile compared to

traditional screws

Head and shaft

advance at same rate

into plate and bone

d) 3.5mm Screw holes: used to place

Zimmer® Universal Locking System

(ULS) locking screws or cortical screws

(non-locking).

e) Clearance holes for NCB Screw holes:

used to place poly-axial locking screws

(NCB Screws) or blue NCB Cable Buttons

(REF 47-2232-060-01) in combination

with cables around the plate and

femoral bone.

Note: Do not use the gold NCB Locking

Plate Cable Button (REF 47-2232-060-

00) or Hex Button (REF 00-2232-002-35)

in any clearance holes for NCB screw

holes on the NCB Periprosthetic Tro-

chanter Plate. If attaching cables, the

blue NCB Cable Button (REF 47-2232-

060-01) must be used in these holes

when the Trochanter plate is attached.

Using the wrong cable fixation option

increases the likelihood of disengage-

ment of the button which can lead to

refracture or damage to the bone.

8NCB® Periprosthetic Femur System – Surgical Technique

The surgical technique is based on well-

known 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 Periprosthetic Femur System

allows for extensive flexibility in the treat-

ment of periprosthetic fractures. The

polyaxial NCB Plate technology, along

with the offset plate holes, 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.

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 com-

bined. 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

Bicortical screw anchorage

around the stem with NCB

Screws

NCB® Periprosthetic Femur System – Surgical Technique 9

NCB Periprosthetic Proximal and

Distal Femur Plates

Innovative Periprosthetic Plate Design

• Specific anatomical fit to the bone in

left and right designs

• Wide plate design in the periprosthetic

region to allow for bicortical screw

fixation around the prosthesis, and

narrow plate design on the rest of the

plate to minimize soft tissue disruption.

MIS Interface

• MIS interface, consisting of three

holes, allows for connection to

the Targeting Device. See surgical

technique REF 97-2370-010-00

for specific instructions.

Diagonal Three Hole Pattern

Diagonal three hole pattern allows for

more screw options:

• Off-set holes allow for easier screw

placement around the prosthesis and

stable bicortical screw fixation. The

holes accommodate 5.0mm NCB

Screws, and two types of 4.0mm NCB

Screws for use when there is minimal

bone around the prosthesis.

• The central holes can accommodate

threaded 5.0mm NCB Unicortical

Screws, threaded Cable Buttons and

Cables, when bicortical fixation cannot

be achieved.

Differently Shaped Scallops

• Reduced and uniform plate stiffness.

• Better plate contouring across solid

cross-sections, away from holes.

Divergent Screw Alignment

• Increased pull-out resistance.

• Reduced risk of fracture due to linear

perforation of the bone.

System Features and Benefits

Divergent Screw Alignment

(plate bottom side)

Diagonal Three Hole

Pattern

Differently Shaped

Scallops

MIS Interface

10 NCB® Periprosthetic Femur System – Surgical Technique

NCB Periprosthetic Proximal

Femur Plate

Trochanter Plate Interface

Two threaded holes allow for connection

with the NCB Periprosthetic Trochanter

Plate to cover periprosthetic fractures in

the trochanteric area.

K-Wire Holes

Two proximal k-wire holes and one distal

k-wire hole allow for easier preliminary

fixation.

Trochanter Plate

In combination with a Proximal Femur

Plate the Trochanter Plate offers usage of

ULS locking screws or cortical screws

(non-locking) to re-attach the greater tro-

chanter.

Additional holes allow for usage of HEX

buttons to fix cables to the NCB Peripros-

thetic Trochanter Plate.

Short Proximal Femur Plate

One adjustment slot is added to this spe-

cific plate which allows for preliminary

fixation of the plate.

NCB Periprosthetic Distal

Femur Plate

95° Angled Distal Hole

The most distal central plate hole is an-

gled at 95° to the plate shaft to allow

screw insertion parallel to the joint. This

can help reduce the fracture and may

facilitate realignment of the anatomic

axis of the femur.

K-Wire Holes

• One proximal k-wire hole aids in pre-

liminary plate fixation to bone.

• Three Distal k-wire holes are parallel to

the most distal central plate hole to aid

in femoral realignment.

K-Wire Holes

95° Angled Distal Hole

Trochanter Plate Interface

95° Angled Distal

K-Wire Holes

NCB® Periprosthetic Femur System – Surgical Technique 11

Broad Screw Options ∅ mm Description

5 NCB Screws

5 NCB Unicortical Screws

5 NCB Cancellous Screws

4 NCB Screws

4 NCB Screws, Deep Thread

3.5 ULS Locking Screw

3.5 Cortical Screw

5 NCB MotionLoc® Screws

NCB Curved Femur Shaft Plate

Symmetric Design

One plate for left and right femurs due

to symmetric design.

Compression Slots

Two compression slots allow 1mm

of compression each.

K-Wire Holes

Two k-wire holes at each end of the plate

allow easier preliminary plate fixation.

Articulated Tension Device Holes

One hole at each end of the plate allows

for connection of the Articulated Tension

Device to achieve additional compression,

if needed.

NCB Periprosthetic Femur

System

Broad Screw Options

Six different NCB Screw types and two

different 3.5mm ULS locking screws

and cortical screws (only for NCB Peri-

prosthetic Trochanter Plate) are offered

with the NCB Periprosthetic Femur

System, to allow both bicortical and

unicortical fixation.

Specific Instruments for Periprosthetic

Fractures

Slightly oversized drill bits and drill guides

are offered with the NCB Periprosthetic

Femur System, to reduce the risk of cracks

in the cement mantle when placing

screws around a cemented prosthesis.

K-Wire Holes

Articulated Tension Device Hole

NCB Instruments for overdrilling into cement

Articulated Tension Device Hole

Compression Slots

12 NCB® Periprosthetic Femur System – Surgical Technique

* Not available in Europe, Middle East, and Africa

Cable Fixation Options

The following products from the Zimmer®

Cable-Ready® Cable Grip

System are compatible with the NCB

Periprosthetic Femur System:

See data sheet REF 97-2232-015-00 for

more specific instructions.

Cable Fixation with

Hex Button

Cable Fixation Options

Cable Fixation with

Cable Button

NCB Locking Plate

Cable Button, 2.5mm, Hex Drive

• Sterile

• Material: Ti6Al4V

REF 47-2232-060-00 Color: Gold*

REF 47-2232-060-01 Color: Blue

Application

This Cable Button is threaded

directly into the NCB Plate hole to

provide a positioning point for

the Cable

Instructions

To insert, use the 2.5mm hex

screwdriver to thread the cable

button in to the plate hole. Do not

fully tighten to allow the slots in

the button to align with the cable.

To remove, use 2.5mm hex

screwdriver to unthread the cable

button from the plate hole.

Note

If adding cables to the NCB screw holes of the NCB

Periprosthetic Trochanter plate, ensure that only the

compatible blue

NCB

Cable Button (REF 47-2232-060-01)

is used. See page 7 for details.

Hex Button, 3.5mm

• Sterile

• Material: C.P. Titanium

REF 00-2232-002-35

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 or directly into the specific

holes of the NCB Periprosthetic

Trochanter Plate.

Cable Assembly Cerclage,

1.8mm

• Sterile

• Material: CoCr

REF 00-2232-002-28

REF 00-2232-004-18

Cable Fixation Options

(NCB Periprosthetic Trochanter Plate)

NCB® Periprosthetic Femur System – Surgical Technique 13

Indications

The NCB Periprosthetic Femur Polyaxial

Locking Plate System is indicated for

temporary internal fixation and stabiliza-

tion of fractures and osteotomies of

long bones, including:

The NCB Periprosthetic Trochanter Plate when used in combination with…

In addition, both combinations are indicated for:

• Re-attachment of the greater trochanter following osteotomy in THA

• Re-attachment of the greater trochanter following fracture of greater trochanter

• Periprosthetic fractures

• Comminuted fractures

• Fractures in osteopenic bone

• Nonunions

• Malunions

NCB Periprosthetic Proximal Femur Plate,

short (Length = 115mm) is indicated for

temporary internal fixation and stabiliza-

tion of fractures and osteotomies of the

greater trochanter.

NCB Periprosthetic

Trochanter Plate

NCB Periprosthetic Proximal Femur

Plates (Length = 245mm, 285mm,

324mm, 363mm, 401mm) is indicated

for temporary internal fixation and stabili-

zation of fractures and osteotomies of the

proximal femur.

Indications and Contraindications

+

+

Contraindications

• 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 extremi-

ties involved

• Loose prosthesis, which requires

immediate revision

• Periprosthetic fractures

• Comminuted fractures

• Supracondylar fractures

• Fractures in osteopenic bone

• Nonunions

• Malunions

• If the NCB Periprosthetic Trochanter

Plate is used in combination with the

NCB Periprosthetic Proximal Femur

Plate short (Length=115mm), Femoral

Neck Fracture is a contraindication as

well

14 NCB® Periprosthetic Femur System – Surgical Technique

Comprehensive classification systems

for periprosthetic femur fractures are

the Vancouver classification for fractures

following Total Hip Arthoplastly (THA),

and the Lewis and Rorabeck Classifi-

cation for fractures following a Total

Knee Arthoplastly (TKA).

Fractures around Hip Implants

According to the Vancouver classifica-

tions, Type B1 (fracture located around

the tip of the hip prosthesis) and

Type C periprosthetic fractures (fracture

located well below the tip of the hip

prosthesis), both with a stable implant,

may be treated with ORIF (Open Reduc-

tion Internal Fixation). For such fractures,

either the NCB Periprosthetic Proximal

Femur Plate or the NCB Curved Femur

Shaft Plate may be used.

Vancouver Classification

Type A Fracture: occurs at the proximal

part of the femur with displacement of

the greater trochanter or lesser trochanter

Type B1 Fracture: occurs around or just

distal to a well-fixed femoral stem

Type B2 Fracture: occurs around or

just distal to a loose femoral stem with

adequate proximal bone

Type B3 Fracture: occurs around or

just distal to a loose femoral stem with

poor proximal bone stock

Type C Fracture: occurs well distal to

the stem tip

Periprosthetic Femur Fracture Classification

Type A

Type B1 Type B3

Type C

Type B2

Vancouver Classification

NCB® Periprosthetic Femur System – Surgical Technique 15

Fractures around Knee Implants

Periprosthetic femoral fractures following

a TKA which are usually treated with

ORIF are Type II fractures of the Lewis

and Rorabeck Classification (displaced

fractures where the knee prosthesis

is intact). For such fractures the NCB

Periprosthetic Distal Femur Plate may be

used.

Lewis and Rorabeck Classification

Type I Fracture: Non-displaced fracture.

Prosthesis intact

Type II Fracture: Displaced fracture.

Prosthesis intact

Type III Fracture: Non-displaced or dis-

placed fracture. Prosthesis loose or failing

Type III

Type I

Type II

Lewis and Rorabeck Classification

16 NCB® Periprosthetic Femur System – Surgical Technique

Recommended NCB Periprosthetic

Plate Positioning

• Ensure that the length of the NCB

Periprosthetic Proximal Femur or Distal

Femur Plate allows for screw placement

around the existing prosthesis along

the diagonal three hole pattern in the

widest area of the plate.

• The widest part of the plate should be

placed on the fracture site. Do not place

the narrow part of the plate over the

fracture site.

NCB Periprosthetic Plate Positioning and Screw Fixation

NCB Periprosthetic Proximal Femur Plate and fracture location

NCB Periprosthetic Distal Femur Plate and fracture location

Narrow plate design Wide plate design: Location of the periprosthetic fracture

Transition

Narrow plate design

Wide plate design: Location of the periprosthetic fracture

Transition

NCB® Periprosthetic Femur System – Surgical Technique 17

Recommended NCB Screw

Fixation

The NCB Periprosthetic Femur System

offers five different types of polyaxial

locking screws, four of them are designed

for bicortical purchase, and one of them

is designed for unicortical purchase.

In addition, Ø5.0mm Zimmer MotionLoc

Screws are also compatible with the NCB

Periprosthetic Femur System and have a

more specific instruction in the Surgical

Technique (REF: 97-3161-004-00).

Recommended NCB Screw usage for NCB

Periprosthetic Proximal Femur and Distal

Femur Plates:

• Use two bicortical 5.0mm NCB Screws

close to the fracture on each side of the

fracture.

• Wherever possible, use 5.0mm bicorti-

cal NCB Screws. For thin cortical bone

near the prosthesis, the 4.0mm NCB

Screws may be used.

Screw Type Cortical

5mm

Cortical

4mm

Cortical

4mm Deep Thread

Cancellous

Partially threaded

Cortical

Blunt Tip

Outer ∅5mm 4mm 4mm 5mm 5mm

Core ∅4.4mm 3.4mm 2.9mm 2.9mm 4.4mm

Length 22–100mm 20–65mm 20–65mm 50–100mm 10–20mm

REF

REF Sterile

02.03150.xxx

02.02150.xxx

02.03155.xxx

02.02155.xxx

02.03154.xxx

02.02154.xxx

02.03152.xxx

02.02152.xxx

02.03151.xxx

02.02151.xxx

Application Close to the fracture

area, in the shaft

area, or where there is

no risk of hitting the

prosthesis

Away from the fracture

area to achieve bicorti-

cal fixation around the

prosthesis

Away from the fracture

area to achieve bicorti-

cal fixation around

the prosthesis when

fixation even with the

4.0mm cortical

standard screws is

impossible

Metaphyseal area of the

Distal Femur

For use when

bicortical fixation

cannot be achieved

Warning

If only unicortical

screws are used,

the use of cables is

required

NCB Screw portfolio for the NCB Periprosthetic Femur System

NCB Screws – Bicortical Unicortical

Tap REF 02.00024.341 02.00024.340 02.00024.305 –02.00024.341

Note: the 4.0mm NCB Screws, deep

thread are only recommended for use

around the implanted prosthesis when

the cortical wall is too thin to use even

with the 4.0mm NCB Screws. They are

not recommended for use near the

fracture site.

The 4.0mm NCB Screws, Deep Thread

have a smaller core diameter than the

4.0mm NCB Screws (2.9mm versus

3.4mm), which allows for a more

aggressive thread design for improved

anchorage in thin bone. Furthermore,

as the core diameter is smaller, less bone

is removed during drilling and screw

insertion.

Drill Bit ∅4.3 / 4.5mm 3.3 / 3.5mm 3.0mm 2.5mm 4.3 / 4.5mm

Drill Bit REF 02.00024.002

02.00024.330*

02.00024.118

02.00024.325*

02.00024.301

–

103.25.180

–

02.00024.002

02.00024.330*

Drill Guide REF 02.00024.011

02.00024.331

02.00024.111

02.00024.326

02.00024.310

–

02.00024.010

–

02.00024.011

02.00024.331

* Titanium nitride coated drill bits for drilling into the cement mantle

18 NCB® Periprosthetic Femur System – Surgical Technique

Recommended Screw Fixation

for NCB Periprosthetic Trochanter

Plate

The NCB Periprosthetic Femur System

offers two additional types of screws to

be used with the NCB Periprosthetic

Trochanter Plate, ULS locking screw and

cortical screw (non-locking).

Recommended Screw usage for NCB

Periprosthetic Trochanter Plates:

• Use at least three 3.5mm screws

placing them both anterior and posterior

to the prosthesis.

• If using two 3.5mm screws in the

most proximal holes to secure

the trochanteric fragment, add two

additional screws distally.

• Screws should be placed through

fracture zone, or osteotomy gap.

FOR EMEA (Europe, Midle East, and Africa) ONLY:

Instead of using the

3.5mm cortical screws from the ULS system

(00-4935-xxx-35) standard 3.5mm cortical

screws (02.03131.xxx) can be implanted as

well.

Screw portfolio for the NCB Periprosthetic Femur System

(Trochanter Plate)

* Longer sizes (60mm – 90mm, 5mm steps) are available upon request sterile packed

** Longer sizes (60mm – 95mm, 5mm steps) are available upon request sterile packed

Screw Type Locking

3.5mm

Cortical

3.5mm

Cortical

3.5mm

Outer ∅3.5mm 3.5mm 3.5mm

Core ∅2.7mm 2.4mm 2.4mm

Length 12–60mm* 12–60mm** 12–60mm

REF

REF Sterile

00-2369-xxx-35

47-2369-xxx-35

00-4935-xxx-01

47-4935-xxx-01

02.03131.xxx

—

Application Trochanteric area in

locked mode

Trochanteric area in

non-locked mode

Trochanteric area in

non-locked mode

Drill Bit ∅2.7mm 2.5mm 2.5mm

Drill Bit REF 00-2360-205-27 00-4807-180-25 00-4807-180-25

Tap REF 00-2360-153-35 00-4811-110-35 00-4811-110-35

Drill Guide REF 00-2360-020-27 00-4808-035-01 00-4808-035-01

ULS Screws Cortical Screws (FOR EMEA ONLY)

NCB® Periprosthetic Femur System – Surgical Technique 19

Shows a standard NCB Plate used in a non periprosthetic fracture.

Indicates recommended NCB Screw fixation for the NCB Periprosthetic

Plate in periprosthetic fractures. Bicortical

screw fixation

with at least four NCB Screws is recommended along the diagonal three hole pattern in the widest section of the plate. Place

screws both anterior and posterior to the prosthesis.

Warning: Do not insert three screws in one diagonal three hole pattern, because it creates a stress riser in the bone.

When no prosthesis is present beneath the plate standard NCB Screw fixation can be applied.

Note: To prevent thread stripping and allow for adequate bone purchase, pass screws as centrally through the

bone

as possible.

In addition, irrigation may be used during drilling to help prevent thermal necrosis.

Demonstrates a situation where four bicortical NCB Screws cannot be placed along the diagonal three hole pattern in the wide

part of the plate. To ensure stable fracture fixation, the use of one or two divergent 5.0mm NCB Unicortical Screws is recom-

mended. If only one bicortical screw can be placed in the offset holes of a given diagonal three hole pattern, place one 5.0mm

NCB Unicortical Screw in the central hole of that three-hole pattern.

Demonstrates a situation where a threaded cable button and cable are used as an optional fixation method, when additional fix-

ation is required.

Recommended NCB Screw fixation

for the NCB Periprosthetic Proximal

Femur and Distal Femur Plates

NCB Screw ∅ 5mm

NCB Screw ∅ 5 or 4mm, or

NCB Screw ∅ 4mm, Deep Thread

NCB Unicortical Screw ∅ 5mm

Cable Ready Cable-Button and Cable

Warning: Do not insert three screws in one

diagonal three hole pattern, because it creates

a stress riser in the bone.

Standard NCB Screw Fixation Standard NCB Screw Fixation

Recommended NCB Periprosthetic Screw Fixation

Standard NCB Screw Fixation

Alternative NCB Periprosthetic Screw Fixation

Standard NCB Screw Fixation

Alternative NCB Periprosthetic Screw Fixation with Cable

Standard NCB Screw Fixation

4.

3.

2.

1.

20 NCB® Periprosthetic Femur System – Surgical Technique

NCB Screw Insertion

For All Types of NCB Screws and

NCB Locking Caps

• Do not hit the prosthesis

with the tip of the drill, tap or screw.

• 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.

• 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.

For Zimmer MotionLoc Screws

See surgical technique REF 97-3161-004-00

for more specific instructions.

NCB 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).

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.

Note: The 4.3mm drill bit can drill a

maximum of 105mm deep when used

with the drill guide. If a longer screw is

needed, remove the drill guide and drill

the additional depth free hand.

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).

3. To lock the construct, insert the NCB

Locking Caps (REF 02.03150.300) as

described at the beginning of this section.

NCB Unicortical Screw ∅ 5.0mm

Warning: If only unicortical screws are

used, the use of cables is required.

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 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).2

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).

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.

3. To lock the construct, insert the NCB

Locking Caps (REF 02.03150.300) as

described at the

beginning of this section.

1, 2 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.

NCB® Periprosthetic Femur System – Surgical Technique 21

Drilling of the locking

holes

NCB Cancellous Screw ∅ 5.0mm

1. To insert a 5.0mm NCB Cancellous

Screw (REF 02.03152.xxx) use the NCB

2.5mm Drill Guide (REF 02.00024.010)

and use the 2.5mm drill bit

(REF 103.25.180).

In case of hard cortical bone drill the

cortex with a 4.3mm drill bit

(REF 02.00024.002) by using the 4.3mm

NCB Drill Guide (REF 02.00024.011).

Note: Use the 5.0mm NCB Cancellous

Screws only in cancellous bone.

Note: The 2.5mm drill bit can drill a

maximum of 90mm deep when used

with the drill guide. If a longer screw

is needed, remove the drill guide and

drill the additional depth free hand.

2. Use the NCB Measuring Device

(REF 02.00024.005) to determine the

appropriate screw length and insert

the NCB Cancellous Screw using the

NCB Hexagonal Screwdriver

(REF 02.00024.023) or screwdriver

shaft (REF 02.00024.024).

Cancellous screws are partially threaded

and can be used as lag screws to reduce

the fracture and obtain close contact

between the plate and the bone.

3. To lock the construct, insert the

NCB Locking Caps (REF 02.03150.300) as

described at the

beginning of this section.

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 pros-

thesis. 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.

NCB Screw

∅ 4.0mm

,

Deep Thread

1. To insert a 4.0mm

NCB

Screw, Deep

Thread (

REF

02.03154.0xx) use the

3.0mm

NCB

Drill Guide (

REF

02.00024.310)

and drill with the 3.0mm drill bit

(

REF

02.00024.301).

In case of hard cortical bone or the pres-

ence of the cement mantle, tap the cortex

with the 4.0mm

NCB

Tap, Deep Thread

(

REF

02.00024.305). Remove the 3.0mm

NCB

Drill Guide before using the

NCB

Tap.

2. Use the

NCB

Measuring Device

(

REF

02.00024.005) to determine the

appropriate screw length and insert the

NCB

Screw, Deep Thread 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.

22 NCB® Periprosthetic Femur System – Surgical Technique

For All Types of 3.5mm Screws

• Do not hit the prosthesis with the tip of

the drill, tap or screw.

• Take care to avoid collision of the

screws by choosing the appropriate

plate holes and screw lengths.

• Screws may be inserted under power

but should be final tightened by hand

only to avoid crossthreading of the

screw in the plate hole or breakage of

the screw or driver.

ULS Locking Screw ∅ 3.5mm

1. To insert a 3.5mm ULS locking screw

(REF 00-2369-xxx-35 / 47-2369-xxx-35)

thread a Standard Drill Cannula 2.7mm

(REF 00-2360-020-27) into the plate hole

where you plan to place the first locking

screw.

2. Insert the 2.7mm Drill Bit (REF

00-2360-205-27) through the cannula

and drill to the appropriate depth. In case

of hard cortical bone or the presence of

a cement mantle, tap the cortex with the

3.5mm Tap (REF 00-2360-153-35).

Remove the cannula and the drill bit

before using the Tap.

3. Use the Depth Gauge (REF 00-2360-

040-35 for screws up to 60mm to deter-

mine the appropriate screw length and

insert the ULS screws using the Small Hex

Screwdriver (REF 00-4812-035-00) or HEX

Screwdriver Shaft (REF 00-2360-165-25).

4. Make sure that all locking screws are

securely tightened before closing.

Cortical Screw ∅ 3.5mm

1. To insert a 3.5mm cortical screw

(REF 00-4935-xxx-01 / 47-4935-xxx-01

or 02.03131.0xx) use the Double Drill

Sleeve (REF 00-4808-035-01) and the

2.5mm Drill Bit (REF 00-4807-180-25).

In case of hard cortical bone or

the presence of a cement mantle, tap

the cortex with the 3.5mm Tap

(REF 00-4811-110-35). Remove the Double

Drill Sleeve before using the Tap.

2. Use the Depth Gauge (REF 00-4810-

002-01) for screws up to 60mm to deter-

mine the appropriate screw length and

insert the cortical screws using the Small

Hex Screwdriver (REF 00-4812-035-00) or

HEX Screwdriver Shaft (REF 00-2360-165-

25).

• While inserting the first cortical screw

be careful not to tilt the plate.

Screw Insertion for NCB Periprosthetic Trochanter Plate

NCB® Periprosthetic Femur System – Surgical Technique 23

Preoperative Planning and

Patient Positioning

Preoperative Planning

Preoperative planning with adequate

x-rays and x-ray templates for the

NCB Periprosthetic Proximal Femur

Plate (Lit 06.02024.000) and the

NCB Periprosthetic Trochanter Plate

(Lit 06.02262.000) is strongly recom-

mended. If necessary, use CT scans

if osteolysis is present.

Patient in the lateral position

Patient in the supine position

NCB Periprosthetic Proximal Femur Plate – Surgical Technique

This allows determination of the proper

plate length, and the appropriate type

and position of screws, particularly in the

presence of a hip prosthesis to prevent

any interference with the hip stem.

Determine which prosthesis has been im-

planted 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 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.

If intra-op fluoro is to be used, ensure

the fluoro machine is not blocked

by radiopaque bars of the operating

table.

+H84406020240001/$100501E10I

© 2010. All rights reserved.

Zimmer GmbH, CH-8404 Winterthur, Switzerland

Lit.No. 06.02024.000 – Ed. 5/2010 WL

NCB

®

Periprosthetic Proximal Femur Plate

0086

10 cm 15 cm5 cm

Magnification

1.15:1

20 cm

15 cm

5 cm

20 cm 25 cm 30 cm

25 cm

30 cm

35 cm

40 cm

45 cm

50 cm

10 cm

10 cm 15 c m

5 cm 20 cm 25 cm 30 cm

9 holes

9 holes

12 holes

12 holes

15 holes

15 holes

18 holes

18 holes

Transition Zone

Transition Zone

1

2

3

4

5 mm

NCB Screw

4 mm

NCB Screw Polyaxiality NCB Unicortical Screw

NCB Screw

NCB Cancellous Screw

NCB Screw Deep Thread

30°

Right

Left

21 holes

21 holes

5 mm

5 mm

4 mm

4

3

21

24 NCB® Periprosthetic Femur System – Surgical Technique

Incision and Intra-operative

Planning

Note: Check to see if the prosthesis is

loose before reduction. If the prosthesis

is loose, revision may be indicated.

Incision

Make the incision using the lateral

subvastus approach or incorporate the

existing incision, if applicable.

Avoid excessive stripping of the soft

tissue and keep the periosteum intact.

Intra-operative Planning

Take complete x-rays of the femur in

the A/P and lateral views, occasional

if necessary in the contra-lateral view to

determine the length of the prosthesis,

as well as the correct plate length

to be implanted. Please refer to pages

14–16.

Note: The prosthesis length as well as the

fracture location determines the plate

length selected, with the length of the

patient’s bone as a secondary guide.

If the length of the prosthesis is

between two plate sizes, choose the

longer one.

If desired, the NCB Periprosthetic

Proximal Femur Plate Provisionals

(REF 02.00024.35x) can be used to

determine the suitable implant length.

Provisionals are semi radiolucent

and intended to be used in the open

technique.

Each provisional represents the implant

sizes it is labeled for e.g. 12 holes. To

use the provisional for the next shorter

implant size (e.g. 9 hole plate), two

square holes are included:

– the proximal square hole indicates the

end of the periprosthetic zone

– the distal square hole indicates the

most distal NCB Plate hole of the next

shorter implant size.

For every size of the NCB Periprosthetic

Trochanter plate a specific provisional is

provided.

Warning: Do not implant or bend the

provisional.

Incision

Excessive stripping of the soft

tissue avoided and periosteum

kept intact

NCB Periprosthetic Proximal

Femur Plate Provisional used

for intra-operative planning

(optional)

Next shorter

implant size

End of

periprosthetic zone

Most distal NCB Screw hole

9 hole plate

Provisional

12 hole plate

Square holes are included

to indicate the next

shorter implant size

NCB® Periprosthetic Femur System – Surgical Technique 25

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. Ensure that preliminary fixation

devices do not interfere with the future

location of the plate and screws, or with

the prosthesis.

Insertion of the NCB

Periprosthetic Proximal Femur

Plate

Lift the vastus lateralis’ origin with an

“L” shaped incision and insert the

appropriate left or right NCB Peri pros the-

tic Proximal Femur plate just below the

vastus tubercle until you achieve good

contact with the bone. Make sure that the

plate is on bone distally as well.

If using the NCB Periprosthetic Trochanter

Plate in combination with the NCB Peri-

prosthetic Proximal Femur Plate make sure

that the two plates are assembled prior to

insertion. Use the NCB DF Torque Screw-

driver 6Nm (REF 02.00024.021) to screw in

the two Connection Screws which come

pre-assembled with the NCB Periprosthet-

ic Trochanter Plate.

Note: Do not use the NCB Periprosthetic

Proximal Femur Plate short or the NCB

Periprosthetic Trochanter Plate as stand-

alone implants! The NCB Periprosthetic

Trochanter always needs to be assembled

with a NCB Periprosthetic Proximal Femur

Plate.

If small bone fragments are present in the

trochanteric region the use of additional

cable osteosynthesis is recommended.

A HEX button can be used in the non-

threaded holes of the NCB Periprosthetic

Trochanter Plate to guide the cable over

the plate.

Surgical Technique Tip: For additional

stability a cable can be used through the

two most proximal holes (foreseen for

HEX buttons) in the NCB Periprosthetic

Trochanter Plate. Leave the cable loose on

the proximal side to have space for the

two proximal 3.5mm screws. After insert-

ing the screws the cable can be placed

around the femoral neck / shaft and tight-

ened.

NCB Periprosthetic Proximal

Femur Plate positioned and

temporarily fixed proximally

and distally with 2.0mm

k-wires

Assembling the NCB

Periprosthetic Trochanter Plate

with the NCB Periprosthetic

Proximal Femur Plate using the

NCB DF Torque Screwdriver 6Nm.

26 NCB® Periprosthetic Femur System – Surgical Technique

Correct orientation of the

concave Bending Press

insert: with the word “TOP”

etched on the top of the

insert

Center the plate on the bone shaft in

the lateral view. Ensure the distal end

of the plate does not lift off the bone

anteriorly or posteriorly which can cause

post-op pain.

Temporarily fix the plate with 2.0mm

k-wires (REF 290.20.280) proximally

and distally.

Note: The NCB Periprosthetic Proximal

Femur

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. Further-

more, the locking mechanism of the NCB

hole may be damaged and, therefore,

may no longer function. Do not use a

hole that has been altered by contouring

for locking. If the plate is bent, the MIS

guide cannot be used.

Note: Do not bend the NCB Periprosthetic

Femur Plate proximal to the MIS interface

or the adjustment slot (short NCB Peri-

prosthetic Proximal Femur Plate) when

used in combination with the NCB Peri-

prosthetic Trochanter Plate, because it

will compromise the attachment between

the two plates.

Note: Do not bend the NCB Periprosthetic

Trochanter Plate.

NCB® Periprosthetic Femur System – Surgical Technique 27

Insertion of the NCB Screws

(without NCB Periprosthetic

Trochanter Plate)

The actual configuration should always

be determined based on the fracture

type and bone quality. For screw

selection and the surgical procedure

on how to insert a NCB Screw, please

refer to pages 17–21.

Note: Ensure that existing other medical

devices and their fixation and/or

anchorage elements are not affected or

damaged by drill bits, taps, or screws.

Insertion of the NCB Screws Proximally

1. Insert a NCB Screw into one of the two

most proximal plate holes.

Note: The screw selection should be

considered with respect to the thickness

of the cortex. For thin cortex, start by

drilling a pilot hole for a 4.0mm NCB

Screw, and subsequently enlarge it for a

5.0mm NCB Screw, if space permits.

Note: Do not fully tighten the first screw

as it may tilt the plate.

2. Insert the second NCB Screw in the

next proximal screw hole of the plate.

After the second screw is inserted in the

proximal screw hole, then both screws

can be tightened.

Note: Screws should not be locked until

the distal fragment has been fixed.

First NCB Screw inserted

in one of the two most proxi-

mal plate holes

Second NCB Screw inserted

in the opposite most

proximal screw hole of the

plate

28 NCB® Periprosthetic Femur System – Surgical Technique

Insertion of the NCB Screws along

the Shaft

3. Insert the third NCB Screw anterior or

posterior to the prosthesis in a diagonal

three hole pattern along the femur shaft

and proximal to the fracture.

4. Insert the fourth NCB Screw in the

opposite hole of the same diagonal

three hole pattern, creating a grip

around the prosthesis.

Note: Bicortical screw fixation of at

least four screws alternating anterior

and posterior to the prosthesis is

recommended.

If there is not enough cortex for two

bicortical screws around the prosthesis

in the same diagonal three hole pattern,

insert one screw bicortically and one

5.0mm NCB Unicortical Screw in the

central hole, to provide stability.

Third NCB Screw inserted

anterior or posterior to

the prosthesis in a diagonal

three hole pattern along

the femur shaft and proximal

to the fracture

Fourth NCB Screw inserted

in the opposite hole of

the same diagonal three

hole pattern, creating a grip

around the prosthesis

NCB® Periprosthetic Femur System – Surgical Technique 29

Insertion of the NCB Screws Distally

Insert at least three bicortical NCB

Screws distal to the fracture area and to

the prosthesis.

Insertion of additional NCB Screws

Insert additional NCB Screws as

necessary to provide optimal fixation

and remove the k-wires.

If screws are not enough, cables can

be added.

At least three bicortical NCB

Screws inserted distal

to the fracture area and to the

prosthesis

Final View

Additional NCB Screws

inserted as necessary to

provide optimal fixation

and k-wires are removed

30 NCB® Periprosthetic Femur System – Surgical Technique

Insertion of the NCB/ULS or

cortical Screws (with NCB

Periprosthetic Trochanter Plate)

The actual configuration should always

be determined based on the fracture

type and bone quality. For screw

selection and the surgical procedure

on how to insert a NCB, ULS or cortical

Screw, please refer to pages 18–22.

Note: Ensure that existing other medical

devices and their fixation and/or

anchorage elements are not affected or

damaged by drill bits, taps, or screws.

Insertion of the NCB Screws Proximally

1. Insert an NCB Screw into one of the

two most proximal plate holes.

Note: The screw selection should be

considered with respect to the thickness

of the cortex. For thin cortex, start by

drilling a pilot hole for a 4.0mm NCB

Screw, and subsequently enlarge it for a

5.0mm NCB Screw, if space permits.

Note: Do not fully tighten the first screw

as it may tilt the plate.

2. Insert the second NCB Screw in the

next proximal screw hole of the plate.

After the second screw is inserted in the

proximal screw hole, then both screws

can be tightened.

First NCB Screw inserted

in one of the two most proxi-

mal plate holes

Second NCB Screw inserted

in the opposite most

proximal screw hole of the

plate

NCB® Periprosthetic Femur System – Surgical Technique 31

Third NCB Screw inserted

anterior or posterior to

the prosthesis in a diagonal

three hole pattern along

the femur shaft and proximal

to the fracture

Fourth NCB Screw inserted

in the opposite hole of

the same diagonal three

hole pattern, creating a grip

around the prosthesis

Note: Screws should not be locked until

the distal fragment has been fixed.

Insertion of the NCB Screws along

the Shaft

3. Insert the third NCB Screw anterior or

posterior to the prosthesis in a diagonal

three hole pattern along the femur shaft

and proximal to the fracture.

4. Insert the fourth NCB Screw in the

opposite hole of the same diagonal three

hole pattern, creating a grip around the

prosthesis.

Note: Bicortical screw fixation of at

least four screws alternating anterior

and posterior to the prosthesis is recom-

mended.

If there is not enough cortex for two

bicortical screws around the prosthesis in

the same diagonal three hole pattern,

insert one screw bicortically and one

5.0mm NCB Unicortical Screw in the

central hole, to provide stability.

Insertion of the NCB Screws Distally

Insert at least three bicortical NCB

Screws distal to the fracture area and to

the prosthesis.

Insertion of additional NCB Screws

Insert additional NCB Screws as

necessary to provide optimal fixation

and remove the k-wires.

If screws are not enough, cables can

be added.

See page 12 for cable fixation options

and instructions.

Note: If adding cables to the NCB screw

holes of the NCB Periprosthetic Trochan-

ter plate, ensure that only the compatible

blue NCB Cable Button (REF 47-2232-

060-01) is used. See page 7 for details.

At least three bicortical NCB

Screws inserted distal

to the fracture area and to the

prosthesis

32 NCB® Periprosthetic Femur System – Surgical Technique

Insertion of the ULS Screws or cortical

screws into the NCB Periprosthetic Tro-

chanter Plate

1. Insert a 3.5mm screw (locking or non-

locking) into one of the two most proxi-

mal screw holes of the plate.

2. Insert the second 3.5mm screw (lock-

ing or non-locking) in the next proximal

screw hole of the Trochanter Plate.

3. Insert additional 3.5mm screws on the

anterior or posterior side of the NCB Peri-

prosthetic Trochanter Plate if necessary.

4. Place additional screws close to the

fracture zone.

Surgical Technique Tip: If you are using a

Cable, tighten the cable before placing

additional 3.5mm screws in NCB Peri-

prosthetic Trochanter Plate.

Final View

Additional 3.5mm screws

inserted as necessary to

provide optimal fixation

and k-wires are removed

1 2

33

NCB® Periprosthetic Femur System – Surgical Technique 33

Preoperative Planning and

Patient Positioning

Preoperative Planning

Preoperative planning with adequate

x-rays and x-ray templates for the NCB

Periprosthetic Distal Femur Plate

(Lit 06.02025.000) is strongly recom-

mended.

This allows for determination of the

proper plate length, and the appropriate

type and position of screws, particularly

in the presence of a knee prosthesis to

prevent any interference with the knee

stem.

Determine which prosthesis has been im-

planted 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 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.

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 lateral position

Patient in the supine position

NCB Periprosthetic Distal Femur Plate – Surgical Technique

+H84406020250001/$100501E10J

© 2010. All rights reserved.

Zimmer GmbH, CH-8404 Winterthur, Switzerland

Lit.No. 06.02025.000 – Ed. 5/2010 WL

NCB

®

Periprosthetic Distal Femur Plate

0086

10 cm 15 cm5 cm

Magnification

1.15:1

20 cm

15 cm

5 cm

20 cm 25 cm 30 cm

25 cm

30 cm

35 cm

40 cm

45 cm

50 cm

10 cm

10 cm 15 c m

5 cm 20 cm 25 cm 30 cm

5 mm

5 mm

4 mm

9 holes

9 holes

12 holes

12 holes

15 holes

15 holes

18 holes

18 holes

Transition Zone

Transition Zone

1

2

3

4

6

5

1

2

3

4

6

5

5 mm

NCB Screw

4 mm

NCB Screw Polyaxiality NCB Unicortical Screw

NCB Screw

NCB Cancellous Screw

NCB Screw Deep Thread

30°

Right

Left

21 holes

21 holes

34 NCB® Periprosthetic Femur System – Surgical Technique

Incision and Intra-operative

Planning

Note: Check to see if the prosthesis is

loose before reduction. If the prosthesis

is loose, revision may be indicated.

Incision

A lateral incision is recommended.

The skin incision should start at Gerdy’s

tubercle and continue proximally to

expose the fracture zone.

Alternatively, incorporate the existing

incision, if applicable.

The muscles should be left attached to

the fracture fragments for optimal blood

supply. Do not strip the periosteum.

Intra-operative Planning

Take complete x-rays of the femur in

the A/P and lateral views, occasional if

necessary 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.

Please refer to pages 14–16.

Note: The prosthesis length as well as

the fracture location should determine

the plate length, with the length of the

patient’s bone as a secondary guide.

If the length of the prosthesis is between

two plate sizes, choose the longer one.

If desired, the NCB Periprosthetic

Distal Femur Plate Provisionals

(REF 02.00024.35x) can be used to

determine the suitable implant length.

Provisionals are semi radiolucent

and intended to be used in the open

technique.

Each provisional represents the implant

sizes it is labeled for, e.g. 12 holes. To

use the provisional for the next shorter

implant size (e.g. 9 hole plate), two

square holes are included:

– the distal square hole indicates the end

of the periprosthetic zone

– the proximal square hole indicates the

most proximal NCB Screw hole of the

next shorter implant size.

Warning:

Do not implant or bend the provisional.

Incision

Excessive stripping of the soft

tissue avoided and periosteum

kept intact

NCB Periprosthetic Distal

Femur Plate Provisional used

for intra-operative planning

(optional)

Next shorter

implant size

End of

periprosthetic zone

Most proximal

NCB Screw hole

9 hole plate

Provisional

12 hole plate

Square holes are included

to indicate the next

shorter implant size

NCB® Periprosthetic Femur System – Surgical Technique 35

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 Periprosthetic

Distal Femur Plate

Insert the appropriate left or right NCB

Periprosthetic Distal Femur plate between

the vastus lateralis muscle and the perios-

teum. Keep the proximal end in continuous

contact with the bone surface during

insertion.

Place the distal end of the plate as distal

as possible, center the plate on the bone

shaft in the lateral view and temporarily fix

the plate with two 2.0mm k-wires distally

and one k-wire proximally (REF 290.20.280).

Avoid hitting the prosthesis.

NCB Periprosthetic Distal

Femur Plate temporarily fixed

with 2.0mm k-wires distally

and proximally

Note: The NCB Periprosthetic Distal Femur

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.

If the plate is bent, the MIS guide cannot

be used.

Correct orientation of the

concave Bending Press

insert: with the word “TOP”

etched on the top of the

insert

36 NCB® Periprosthetic Femur System – Surgical Technique

Insertion of the NCB Screws

The following configuration is one

of many possibilities.

The actual configuration should always

be determined based on the fracture type

and bone quality. For screw selection and

the instruction on how to insert a NCB

Screw, please refer to pages 17–21.

Note: Ensure that existing intramedullary

systems and their fixation and/or

anchorage elements are not affected or

damaged by drill bits, taps, or screws.

Insertion of the NCB Screws Distally

1. Insert a 5.0mm NCB Screw (cortical

or cancellous) in the distal fragment.

While tightening the first screw, ensure

that the plate does not tilt.

First NCB Screw inserted in

the distal fragment

Second NCB Screw inserted in

the distal fragment

Note: The two distal k-wire holes are

aligned at 95° to the plate shaft and are

parallel to the most distal central screw

hole to facilitate realignment of the shaft

to the anatomic axis of the femur.

It is very important that the plate main-

tains its position once it has been aligned

with the joint.

Optional

4.3mm cannula for 95° screw

insertion threaded into the

most distal central NCB Screw

hole of the NCB Periprosthetic

Distal Femur Plate, to facilitate

realignment of the femoral

shaft to the joint.

NCB® Periprosthetic Femur System – Surgical Technique 37

Third NCB Screw inserted

anterior or posterior to

the prosthesis in a diagonal

three hole pattern along

the femur shaft and distal to

the fracture

Fourth NCB Screw inserted in

the opposite hole of the same

diagonal three hole pattern,

creating a grip around the

prosthesis

Optionally, the 4.3mm cannula for 95°

screw insertion (REF 02.00024.320)

can be used in the most distal central

plate hole. For 5.0mm NCB Cancellous

Screw insertion, the 2.5mm insert

(REF 02.00024.321) should be placed

inside the cannula. The drill path created

by using these instruments should be

parallel to the knee joint to aid in realign-

ing the anatomic axis of the femur. The

screw used in this hole should be locked

immediately after insertion to maintain

alignment.

2. Insert a second 5.0mm NCB Screw

(cortical or cancellous) in the distal

fragment.

Note: Except for the screw in the most

distal central plate hole used to aid in

realigning the anatomic axis of the femur,

distal screws should not be locked until

the proximal fragment has been fixed.

Insertion of the NCB Screws along

the Shaft

3. Insert a third NCB Screw anterior or

posterior to the prosthesis in a diagonal

three hole pattern along the femur shaft

and distal to the fracture.

Note: The screws should be chosen

based on the thickness of the cortex. For

thin cortical bone start by drilling a pilot

hole for a 4.0mm NCB Screw, and subse-

quently enlarge it for a 5.0mm NCB

Screw, if space permits.

38 NCB® Periprosthetic Femur System – Surgical Technique

4. Insert the fourth NCB Screw in the

opposite hole of the same diagonal three

hole pattern, creating a grip around the

prosthesis.

Note: Bicortical fixation of at least four

screws alternating anterior and posterior

to the prosthesis is recommended. If

there is not enough cortex for two bicorti-

cal screws around the prosthesis in the

same diagonal three hole pattern, insert

one screw bicortically and one 5.0mm

NCB Unicortical Screw in the central hole,

to provide stability.

Insertion of the NCB Screws Proximally

Insert at least three bicortical NCB

Screws proximal to the fracture area and

to the prosthesis.

Insertion of Additional NCB Screws

Insert additional NCB Screws as neces-

sary to provide optimal fixation and

remove the k-wires.

At least three bicortical NCB

Screws inserted proximal

to the fracture area and to the

prosthesis

Final View

Additional NCB Screws

inserted as necessary to

provide optimal fixation

and k-wires are removed

NCB® Periprosthetic Femur System – Surgical Technique 39

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 in the lateral position

Patient in the supine position

NCB Curved Femur Shaft Plate – Surgical Technique

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.

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 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.

If intra-op fluoro is to be used, ensure

the fluoro machine is not blocked by

radioopaque bars of the operating table.

+H84406020260001/$100501E10K

© 2010. All rights reserved.

Zimmer GmbH, CH-8404 Winterthur,

Switzerland

Lit.No. 06.02026.000 – Ed. 5/2010 WL

NCB

®

Curved Femur Shaft Plate

0086

10 cm 15 cm5 cm

Magnification

1.15:1

20 cm

15 cm

5 cm

25 cm

30 cm

35 cm

10 cm

10 cm 15 cm

5 cm

12 holes

14 holes

10 holes

12 holes

10 holes

14 holes

NCB Screw Polyaxiality NCB Screw

5 mm

30°

40 NCB® Periprosthetic Femur System – Surgical Technique

Incision and Intra-operative

Planning

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 in-

tact.

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 radio-

lucent and intended to be used in the

open technique.

There is only one provisional which

re presents 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.

Warning:

Do not implant or bend the provisional.

Incision

Exessive stripping of the

soft tissue avoided and

periosteum kept intact

NCB Curved Femur Shaft

Plate Provisional used for

intra-operative planning

(optional)

Next shorter

implant size

Last NCB Plate hole

Last NCB Plate hole

10 hole plate

Provisional

12 hole plate

Square holes are included

to indicate the next

shorter implant size

NCB® Periprosthetic Femur System – Surgical Technique 41

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 for-

ceps. 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.

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.

NCB Curved Femur Shaft Plate

centered over the fracture

and temporarily fixed with two

2.0mm k-wires

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

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.

42 NCB® Periprosthetic Femur 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 compres-

sion, insert the NCB Screws into the com-

pression 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 17–21.

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 compres-

sion 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 with-

out tightening it, and k-wires

removed

* Not included in NCB Periprosthetic Femur instrument set.

NCB® Periprosthetic Femur System – Surgical Technique 43

2. Partially insert a 5.0mm 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).

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.

K-wires removed and axial

compression achieved

by tightening the 5.0mm

NCB Screws in the two com-

pression slots

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

44 NCB® Periprosthetic Femur System – Surgical Technique

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)

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.

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.

Note: Insert the bone spacers into the

NCB Screw holes before plate insertion.

The spacers are single use only, and

they can be removed after locking

the screws.

NCB Blind Screws inserted in

a NCB Plate to prevent bone

ingrowth

NCB Bone Spacers (Optional)

To prevent bone ingrowth into empty NCB

Screw holes, use the NCB Blind Screw

Inserts (REF 02.03150.310).

Note: Hand tighten only.

NCB Blind Screw Inserts (Optional)

Blind Screw Insert

Spacer 1 to 3 mm

NCB® Periprosthetic Femur System – Surgical Technique 45

4 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.

Drilling into Cement Mantle

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.

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:

• 3.0mm drill bit (REF 02.00024.301)

• 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

Periproshetic Femur 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 offered together with

their corresponding drill guides.

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.4

Drilling into Cortical Bone

In order to go around the stem of the

prosthesis and achieve bicortical

fixation with the offset holes of the

diagonal three hole pattern, it may

be necessary to drill completely into

cortical bone, which can lead to

heat necrosis of the bone.

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 patients with thin cortical bone,

away from the fracture area, use NCB

screws of a smaller diameter like the

4.0mm NCB Screws, or the 4.0mm

NCB Deep Thread Screws.

Metal Abrasion Wear

Metal abrasion wear due to contact

between screws, plates, prostheses,

cable buttons, and cables may occur.

Tip, which may Mitigate this Risk

Use only Zimmer products compatible

with the NCB Periprosthetic Femur

System, which are described in this

surgical technique.

Tips and Tricks for the NCB Periprosthetic Femur System

46 NCB® Periprosthetic Femur System – Surgical Technique

To remove the NCB Periprosthetic Proxi-

mal Femur, Distal Femur, and Curved

Femur Shaft Plates, first remove all lock-

ing caps (REF 02.03150.300). Then,

loosen all the NCB Screws without com-

pletely 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.

It is possible to remove only the NCB

Periprosthetic Trochanter Plate and leave

the NCB Periprosthetic Proximal Femur

Plate in place. Do not forget to remove

the two connection screws using the

3.5mm Hex screwdriver.

Implant Removal

NCB® Periprosthetic Femur System – Surgical Technique 47

Product Information – Implants

NCB Periprosthetic Proximal Femur Plates,

Ti6Al4V

Right

REF REF Sterile Holes Length mm

— 02.02263.000 N/A 115

02.03263.009 02.02263.009 9 245

02.03263.012 02.02263.012 12 285

02.03263.015 02.02263.015 15 324

02.03263.018 02.02263.018 18 363

02.03263.021 02.02263.021 21 401

Left

— 02.02263.100 N/A 115

02.03263.109 02.02263.109 9 245

02.03263.112 02.02263.112 12 285

02.03263.115 02.02263.115 15 324

02.03263.118 02.02263.118 18 363

02.03263.121 02.02263.121 21 401

NCB Periprosthetic Trochanter Plates*,

Ti6Al4V

REF REF Sterile Size

– 02.02263.201 right narrow

– 02.02263.202 right wide

– 02.02263.301 left narrow

– 02.02263.302 left wide

Connection Screw for NCB Periprosthetic Trochanter

Plate, Ti6Al4V

REF REF Sterile

– 02.02266.002

Plates

Materials

NCB Periprosthetic Plates and Screws are made of Ti6Al4V,

ISO 5832-3, ASTM F136

* The NCB Periprosthetic Trochanter Plate is packed together with two connection screws which are preassembled.

NCB Periprosthetic Distal Femur Plates,

Ti6Al4V

Right

REF REF Sterile Holes Length mm

02.03264.009 02.02264.009 9 238

02.03264.012 02.02264.012 12 278

02.03264.015 02.02264.015 15 317

02.03264.018 02.02264.018 18 355

02.03264.021 02.02264.021 21 393

Left

02.03264.109 02.02264.109 9 238

02.03264.112 02.02264.112 12 278

02.03264.115 02.02264.115 15 317

02.03264.118 02.02264.118 18 355

02.03264.121 02.02264.121 21 393

NCB Curved Femur Shaft Plates,

Ti6Al4V

REF REF Sterile Holes Length mm

02.03265.010 02.02265.010 10 210

02.03265.012 02.02265.012 12 249

02.03265.014 02.02265.014 14 289

48 NCB® Periprosthetic Femur System – Surgical Technique

NCB Cancellous Screws, ∅ 5.0mm, 32mm Thread

Ti6Al4V

REF REF Sterile Length mm

02.03152.050 02.02152.050 50

02.03152.055 02.02152.055 55

02.03152.060 02.02152.060 60

02.03152.065 02.02152.065 65

02.03152.070 02.02152.070 70

02.03152.075 02.02152.075 75

02.03152.080 02.02152.080 80

02.03152.085 02.02152.085 85

02.03152.090 02.02152.090 90

02.03152.095 02.02152.095 95

02.03152.100 02.02152.100 100

∅ 5 ∅ 6.2

∅ 2.9

L

1.75

NCB Locking Caps, Spacers, Blind Screw Inserts,

Ti6Al4V

REF REF Sterile Description

02.03150.300 02.02150.300 Locking cap

02.03150.310 02.02150.310 Blind screw insert

02.03150.311 02.02150.311 Spacer 1mm

02.03150.312 02.02150.312 Spacer 2mm

02.03150.313 02.02150.313 Spacer 3mm

NCB Screws, ∅ 5.0mm

Ti6Al4V

REF REF Sterile Length mm

02.03150.022 02.02150.022 22

02.03150.024 02.02150.024 24

02.03150.026 02.02150.026 26

02.03150.028 02.02150.028 28

02.03150.030 02.02150.030 30

02.03150.032 02.02150.032 32

02.03150.034 02.02150.034 34

02.03150.036 02.02150.036 36

02.03150.038 02.02150.038 38

02.03150.040 02.02150.040 40

02.03150.042 02.02150.042 42

02.03150.044 02.02150.044 44

02.03150.046 02.02150.046 46

02.03150.048 02.02150.048 48

02.03150.050 02.02150.050 50

02.03150.055 02.02150.055 55

02.03150.060 02.02150.060 60

02.03150.065 02.02150.065 65

02.03150.070 02.02150.070 70

02.03150.075 02.02150.075 75

02.03150.080 02.02150.080 80

02.03150.085 02.02150.085 85

02.03150.090 02.02150.090 90

02.03150.095 02.02150.095 95

02.03150.100 02.02150.100 100

Screws

Materials

NCB Periprosthetic Plates, Screws, Locking Caps, Spacers, and Blind Screw Inserts

are made of Ti6Al4V, ISO 5832-3, ASTM F136

∅ 4.4 ∅ 6.2∅ 5

1.75

L

NCB Unicortical Screws, ∅ 5.0mm,

Ti6Al4V

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

∅ 4.4 ∅ 6.2

∅ 5

L

1.75

NCB® Periprosthetic Femur System – Surgical Technique 49

NCB Screws ∅ 4.0mm, Deep Thread,

Ti6Al4V

REF REF Sterile Length mm

02.03154.020 02.02154.020 20

02.03154.022 02.02154.022 22

02.03154.024 02.02154.024 24

02.03154.026 02.02154.026 26

02.03154.028 02.02154.028 28

02.03154.030 02.02154.030 30

02.03154.032 02.02154.032 32

02.03154.034 02.02154.034 34

02.03154.036 02.02154.036 36

02.03154.038 02.02154.038 38

02.03154.040 02.02154.040 40

02.03154.042 02.02154.042 42

02.03154.044 02.02154.044 44

02.03154.046 02.02154.046 46

02.03154.048 02.02154.048 48

02.03154.050 02.02154.050 50

02.03154.055 02.02154.055 55

02.03154.060 02.02154.060 60

02.03154.065 02.02154.065 65

ULS Screws ∅ 3.5mm, Cortical

Ti6Al4V

REF REF Sterile Length mm

00-4935-012-01 47-4935-012-01 12

00-4935-014-01 47-4935-014-01 14

00-4935-016-01 47-4935-016-01 16

00-4935-018-01 47-4935-018-01 18

00-4935-020-01 47-4935-020-01 20

00-4935-022-01 47-4935-022-01 22

00-4935-024-01 47-4935-024-01 24

00-4935-026-01 47-4935-026-01 26

00-4935-028-01 47-4935-028-01 28

00-4935-030-01 47-4935-030-01 30

00-4935-032-01 47-4935-032-01 32

00-4935-034-01 47-4935-034-01 34

00-4935-036-01 47-4935-036-01 36

00-4935-038-01 47-4935-038-01 38

00-4935-040-01 47-4935-040-01 40

00-4935-045-01 47-4935-045-01 45

00-4935-050-01 47-4935-050-01 50

00-4935-055-01 47-4935-055-01 55

00-4935-060-01 47-4935-060-01 60

∅ 2.9 ∅ 6.2∅ 4

L

1.75

NCB Screws, ∅ 4.0mm

Ti6Al4V

REF REF Sterile Length mm

02.03155.020 02.02155.020 20

02.03155.022 02.02155.022 22

02.03155.024 02.02155.024 24

02.03155.026 02.02155.026 26

02.03155.028 02.02155.028 28

02.03155.030 02.02155.030 30

02.03155.032 02.02155.032 32

02.03155.034 02.02155.034 34

02.03155.036 02.02155.036 36

02.03155.038 02.02155.038 38

02.03155.040 02.02155.040 40

02.03155.042 02.02155.042 42

02.03155.044 02.02155.044 44

02.03155.046 02.02155.046 46

02.03155.048 02.02155.048 48

02.03155.050 02.02155.050 50

02.03155.055 02.02155.055 55

02.03155.060 02.02155.060 60

02.03155.065 02.02155.065 65

ULS Screws ∅ 3.5mm, Locking

Ti6Al4V

REF REF Sterile Length mm

00-2369-012-35 47-2369-012-35 12

00-2369-014-35 47-2369-014-35 14

00-2369-016-35 47-2369-016-35 16

00-2369-018-35 47-2369-018-35 18

00-2369-020-35 47-2369-020-35 20

00-2369-022-35 47-2369-022-35 22

00-2369-024-35 47-2369-024-35 24

00-2369-026-35 47-2369-026-35 26

00-2369-028-35 47-2369-028-35 28

00-2369-030-35 47-2369-030-35 30

00-2369-032-35 47-2369-032-35 32

00-2369-034-35 47-2369-034-35 34

00-2369-036-35 47-2369-036-35 36

00-2369-038-35 47-2369-038-35 38

00-2369-040-35 47-2369-040-35 40

00-2369-042-35 47-2369-042-35 42

00-2369-044-35 47-2369-044-35 44

00-2369-046-35 47-2369-046-35 46

00-2369-048-35 47-2369-048-35 48

00-2369-050-35 47-2369-050-35 50

00-2369-052-35 47-2369-052-35 52

00-2369-054-35 47-2369-054-35 54

00-2369-056-35 47-2369-056-35 56

00-2369-058-35 47-2369-058-35 58

00-2369-060-35 47-2369-060-35 60

∅ 3.4 ∅ 6.2∅ 4

L

1.75

∅ 2.7

∅ 1.0 L

∅ 3.5 ∅ 5.6 ∅ 5.9∅ 3.5∅ 2.4

1.25

L

Materials

NCB Screws and ULS Screws are made of Ti6Al4V,

ISO 5832-3, ASTM F136.

50 NCB® Periprosthetic Femur System – Surgical Technique

Cortical Screws, ∅ 3.5mm (EMEA only),

Ti6Al7Nb

REF REF Sterile Length mm

02.03131.012 – 12

02.03131.014 – 14

02.03131.016 – 16

02.03131.018 – 18

02.03131.020 – 20

02.03131.022 – 22

02.03131.024 – 24

02.03131.026 – 26

02.03131.028 – 28

02.03131.030 – 30

02.03131.032 – 32

02.03131.034 – 34

02.03131.036 – 36

02.03131.038 – 38

02.03131.040 – 40

02.03131.045 – 45

02.03131.050 – 50

02.03131.055 – 55

02.03131.060 – 60

∅ 5.9∅ 3.5∅ 2.4

1.25

L

**NCB MotionLoc Screws, ∅ 5.0mm Cortical,

Self Tapping, Ti6Al4V

REF REF Sterile Length mm

02.03161.030 02.02161.030 30

02.03161.032 02.02161.032 32

02.03161.034 02.02161.034 34

02.03161.036 02.02161.036 36

02.03161.038 02.02161.038 38

02.03161.040 02.02161.040 40

02.03161.042 02.02161.042 42

02.03161.044 02.02161.044 44

02.03161.046 02.02161.046 46

02.03161.048 02.02161.048 48

02.03161.050 02.02161.050 50

02.03161.052 02.02161.052 52

02.03161.054 02.02161.054 54

02.03161.056 02.02161.056 56

02.03161.058 02.02161.058 58

02.03161.060 02.02161.060 60

Compatible Zimmer Products with the NCB Periprosthetic Femur System

REF sterile Description

47-2232-060-00*

NCB Polyaxial Locking Plate Cable Button, Gold, 2.5mm Hex Drive, Material: Ti6Al4V

47-2232-060-01

NCB Polyaxial Locking Plate Cable Button, Blue, 2.5mm Hex Drive, Material: Ti6Al4V

00-2232-002-35 Hex Buttons, 3.5mm Hex, Material: C.P. Titanium

00-2232-002-28 Cable-Ready Cable Assembly Cerclage, ∅ 1.8mm, L. 914mm, Material: CoCr

00-2232-004-18 Cable-Ready Cable Assembly Cerclage, ∅ 1.8mm, L. 635mm, Material: CoCr

Materials

3.5mm Cortical Screws are made of Ti6Al7Nb, ISO 5832-11, ASTM F1295;

the NCB Screws are made of Ti6Al4V, ISO 5832-3, ASTM F136.

* Not available in Europe, Middle East, and Africa

**

MotionLoc screws are compatible with the NCB PP Femur plates only in United States (US), Australia/New Zealand, Canada,

European Union (EU), European Free Trade Association (EFTA), South Korea, Singapore, Taiwan and Thailand

∅ 6.2

∅ 5

L

NCB® Periprosthetic Femur System – Surgical Technique 51

NCB Periprosthetic Femur Standard Instruments

REF Description

02.00024.002 NCB Drill Bit ∅ 4.3mm, L. 195mm

02.00024.005 NCB Measuring Device, L. 110mm

02.00024.010 NCB Drill Guide ∅ 2.5mm

02.00024.011 NCB Drill Guide ∅ 4.3mm

02.00024.021 NCB DF Torque Screwdriver, 6Nm, L. 280mm

02.00024.023 NCB Hexagonal Screwdriver for femur SW 3.5

02.00024.024 NCB Hexagonal Screwdriver shaft SW 3.5

02.00024.111 NCB Drill Guide ∅ 3.3mm for screws ∅ 4.0/4.5mm

02.00024.118 NCB Drill Bit ∅ 3.3mm, with quick coupling L. 195mm

02.00024.121 NCB Locking screw holder for hexagonal screwdriver 3.5mm

02.00024.315 Bending press insert, concave

02.00024.316 Bending press insert, convex

02.00024.320 NCB Periprosthetic cannula ∅ 4.3mm for 95° screw insertion

02.00024.321 NCB Periprosthetic insert ∅ 2.5mm, for use with 4.3mm cannula

02.00024.335 NCB Compression Drill Guide for 5.0mm screws

02.00024.340 NCB Tap ∅ 4.0mm, with quick coupling, L. 250mm

02.00024.341 NCB Tap ∅ 5.0mm, with quick coupling, L. 250mm

02.00024.364 NCB Plate Inserter with 2mm cannulation

100.90.005 Self-holding screw forceps

100.90.210 T-handle with quick coupling for taps

103.25.180 Two-fluted drill bit ∅ 2.5mm, with quick coupling, L. 154/180mm

109.01.020 Small hexagonal screwdriver without holding sleeve, hexagon 2.5mm

290.20.280 Kirschner wire with trocar tip ∅ 2mm, L. 280mm

NCB Periprosthetic Trochanter Standard Instruments

REF Description

00-4806-110-25 Drill Bit, Q/C, ∅ 2.5mm, L. 110mm

00-4806-110-35 Drill Bit, Q/C, ∅ 3.5mm, L. 110mm

00-4808-035-01 3.5mm/2.5mm Double Drill Sleeve

00-4809-035-00 Countersink, Q/C, for 3.5mm and 4.0mm screws

00-4810-002-01 Small Depth Gauge for 2.7/3.5/4.0 screws to 60mm

00-4811-110-35 Tap ∅ 3.5mm, with quick coupling, L. 110mm (for cortical screws)

00-4812-000-00 Screw holding forceps

00-4812-035-00 Small Hex Screwdriver, 2.5mm Hex

00-2360-165-25 Small Hex Screwdriver Shaft, with Q/C, 2.5mm Hex, 140mm

00-4812-035-05 Holding sleeve for small hexagonal screwdrivers

00-2360-020-27 2.7mm Drill Standard Cannula

00-2360-040-35 Locking Small Depth Gauge

00-2360-088-00 Cannula inserter

00-2360-205-27 2.7mm Standard Drill, QC, 205mm long

00-2360-153-35 Tap ∅ 3.5mm, with quick coupling, L. 110mm (for locking screws)

Standard Instruments

Product Information – Instruments

52 NCB® Periprosthetic Femur System – Surgical Technique

NCB Instruments for NCB Screws, ∅ 4mm, Deep Thread

REF Description

02.00024.301 NCB Drill Bit ∅ 3.0mm, with quick coupling, L. 195mm

02.00024.305 NCB Tap ∅ 4.0mm, with quick coupling, for deep thread screw, L. 250mm

02.00024.310 NCB Drill Guide ∅ 3.0mm

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

REF Description

02.00024.325 NCB Drill Bit ∅ 3.5mm, with quick coupling, L. 195mm

02.00024.326 NCB Drill Guide ∅ 3.5mm

02.00024.330 NCB Drill Bit ∅ 4.5mm, with quick coupling, L. 195mm

02.00024.331 NCB Drill Guide ∅ 4.5mm

NCB Long Instruments

REF Description

02.00024.340 NCB Tap ∅ 4.0mm, with quick coupling, L. 250mm

02.00024.341 NCB Tap ∅ 5.0mm, with quick coupling, L. 250mm

02.00024.342 NCB Drill Bit ∅ 2.5mm, with quick coupling, L. 245mm

02.00024.343 NCB Drill Guide ∅ 2.5mm, long

02.00024.344 NCB Drill Bit ∅ 3.3mm, with quick coupling, L. 245mm

02.00024.345 NCB Drill Guide ∅ 3.3mm, long

02.00024.346 NCB Drill Bit ∅ 4.3mm, with quick coupling, L. 245mm

02.00024.347 NCB Drill Guide ∅ 4.3mm, long

02.00024.348 NCB Periprosthetic cannula ∅ 4.3mm for 95° screw insertion, long

NCB Instruments for Lagging NCB Screws

REF Description

02.00024.360 NCB Drill Bit ∅ 4.0mm, with quick coupling, L. 245mm

02.00024.361 NCB Drill Guide ∅ 4.0mm, long

NCB Periprosthetic Femur Provisionals

REF Description

02.00024.350 NCB Periprosthetic Proximal Femur Plate Provisional, right, 15/18 hole plates

02.00024.351 NCB Periprosthetic Proximal Femur Plate Provisional, left, 15/18 hole plates

02.00024.352 NCB Periprosthetic Proximal Femur Plate Provisional, right, 9/12 hole plates

02.00024.353 NCB Periprosthetic Proximal Femur Plate Provisional, left, 9/12 hole plates

02.00024.354 NCB Periprosthetic Distal Femur Plate Provisional, right, 15/18 hole plates

02.00024.355 NCB Periprosthetic Distal Femur Plate Provisional, left, 15/18 hole plates

02.00024.356 NCB Periprosthetic Distal Femur Plate Provisional, right, 9/12 hole plates

02.00024.357 NCB Periprosthetic Distal Femur Plate Provisional, left, 9/12 hole plates

02.00024.358 NCB Curved Femur Shaft Plate Provisional, 10/12/14 hole plates

NCB Periprosthetic Trochanter Provisionals

REF Description

02.00024.411 NCB Periprosthetic Trochanter Plate Provisional, narrow, right

02.00024.412 NCB Periprosthetic Trochanter Plate Provisional, narrow, left

02.00024.413 NCB Periprosthetic Trochanter Plate Provisional, wide, right

02.00024.414 NCB Periprosthetic Trochanter Plate Provisional, wide, left

Optional Instruments

NCB® Periprosthetic Femur System – Surgical Technique 53

Graphic Cases for the NCB Periprosthetic Femur System

Standard Graphic Cases

REF Description

02.00024.901 NCB Periprosthetic Plate System, Femur Plates, base

02.00024.902 NCB Periprosthetic Plate System, Femur Screws and Instruments, base and trays

02.00024.903 NCB Periprosthetic Plate System, Femur Screws and Instruments, base

02.00024.904 NCB Periprosthetic Plate System, Femur Screws and Instruments, standard screw caddy

02.00024.905 NCB Periprosthetic Plate System, Femur Screws and Instruments, deep thread screw caddy

02.00024.906 NCB Periprosthetic Plate System, Femur Screws and Instruments, tray

02.00024.907 NCB Periprosthetic Plate System, Femur Screws and Instruments, locking caps and spacers

02.00024.930 NCB Periprosthetic Trochanter Plate, Add-On set

02.00024.931 NCB Periprosthetic Trochanter Plate, Add-On set, base

02.00024.932 NCB Periprosthetic Trochanter Plate, Add-On set, screw caddy

02.00024.933 NCB Periprosthetic Trochanter Plate, Add-On set, top tray

02.00024.934 NCB Periprosthetic Trochanter Plate, Add-On set, bottom tray

00-5900-099-00 Generic Stackable Lid Assembly

Optional Graphic Cases

REF Description

02.00024.908 NCB Periprosthetic Plate System, Femur Provisionals, base

02.00024.909 NCB Periprosthetic Plate System, Add-On to NCB-DF, base and trays

02.00024.910 NCB Periprosthetic Plate System, Add-On to NCB-DF, base

02.00024.911 NCB Periprosthetic Plate System, Add-On to NCB-DF, screw caddy

02.00024.912 NCB Periprosthetic Plate System, Add-On to NCB-DF, tray

00-5900-099-00 Generic Stackable Lid Assembly

REF Description

02.02024.342 NCB Drill Bit ∅ 2.5mm, with quick coupling, L=245mm

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

Sterile Instruments

54 NCB® Periprosthetic Femur System – Surgical Technique

NCB Periprosthetic Trochanter Plate X-ray Template

Lit.No. 06.02262.000

Lit.No. 97-2370-008-00 (US only)

+H84406022620001/$120101A12I

Lit.No. 06.02262.000 – Ed. 2012-01 WL

NCB® Periprosthetic Trochanter Plate

© 2012. All rights reserved.

Zimmer GmbH, CH-8404 Winterthur,

Switzerland

10 cm 15 cm5 cm

Magnification

1.15:1

20 cm

15 cm

5 cm

20 cm 25 cm

25 cm

30 cm

35 cm

40 cm

45 cm

50 cm

10 cm

10 cm 15 cm

5 cm 20 cm 25 cm

2

1

3

5

7

4

6

8

21

3

5

7

4

6

8

12

3

4

5

6

78

8

Narrow

1

2

34

56

78

12

34

56

78

Right

Left

5 mm

4 mm

4 mm

NCB Screw

NCB Screw Polyaxiality

5 mm

5 mm

NCB Unicortical Screw

NCB Screw

NCB Cancellous Screw

NCB Screw Deep Thread

30°

12

3

4

5

6

7

Wide

3.5 mm

ULS Locking Screw Cortical Screw

3.5 mm

Planning Aid

NCB Periprosthetic Proximal Femur Plate X-ray Template

Lit.No. 06.02024.000

Lit.No. 97-2370-050-02 (US only)

+H84406020240001/$111201L11P

Lit.No. 06.02024.000 – Ed. 2011-12 WL

NCB® Periprosthetic Proximal Femur Plate

© 2011. All rights reserved.

Zimmer GmbH, CH-8404 Winterthur,

Switzerland

10 cm 15 cm5 cm

Magnification

1.15:1

20 cm

15 cm

5 cm

20 cm 25 cm 30 cm

25 cm

30 cm

35 cm

40 cm

45 cm

50 cm

10 cm

10 cm 15 cm

5 cm 20 cm 25 cm 30 cm

5 mm

5 mm

5 mm

4 mm

4 mm

9 holes

9 holes

12 holes

12 holes

15 holes

15 holes

18 holes

18 holes

Transition Zone

Transition Zone

1

2

3

4

NCB Screw

NCB Screw Polyaxiality NCB Unicortical Screw

NCB Screw

NCB Cancellous Screw

NCB Screw Deep Thread

30°

Right

Left

21 holes

21 holes

4

3

21

NCB® Periprosthetic Femur System – Surgical Technique 55

NCB Curved Femur Shaft Plate X-ray Template

Lit.No. 06.02026.000

Lit.No. 97-2370-050-03 (US only)

+H84406020260001/$111201L11R

Lit. No. 06.02026.000 – Ed. 2011-12 WL

© 2011. All rights reserved.

Zimmer GmbH, CH-8404 Winterthur,

Switzerland

NCB® Curved Femur Shaft Plate

10 cm 15 cm5 cm

Magnification

1.15:1

20 cm

15 cm

5 cm

25 cm

30 cm

35 cm

10 cm

10 cm 15 cm

5 cm

12 holes

14 holes

10 holes

12 holes

10 holes

14 holes

NCB Screw Polyaxiality NCB Screw

5 mm

30°

NCB Periprosthetic Distal Femur Plate X-ray Template

Lit.No. 06.02025.000

Lit.No. 97-2370-050-01 (US only)

+H84406020250001/$111201L11Q

© 2011. All rights reserved.

Zimmer GmbH, CH-8404 Winterthur,

Switzerland

Lit.No. 06.02025.000 – Ed. 2011-12 WL

NCB® Periprosthetic Distal Femur Plate

10 cm 15 cm5 cm

Magnification

1.15:1

20 cm

15 cm

5 cm

20 cm 25 cm 30 cm

25 cm

30 cm

35 cm

40 cm

45 cm

50 cm

10 cm

10 cm 15 cm

5 cm 20 cm 25 cm 30 cm

5 mm

5 mm

5 mm

4 mm

9 holes

9 holes

12 holes

12 holes

15 holes

15 holes

18 holes

18 holes

Transition Zone

Transition Zone

1

2

3

4

6

5

1

2

3

4

6

5

NCB Screw

NCB Screw Polyaxiality NCB Unicortical Screw

NCB Screw

NCB Cancellous Screw

NCB Screw Deep Thread

30°

Right

Left

21 holes

21 holes

4 mm

Contact your Zimmer representative or visit us at www.zimmer.com

Copyright 2015 by Zimmer GmbH Printed in Switzerland Subject to change without notice

Lit.No. 06.02013.012 – Ed. 2015-05 ZHUB

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 advice 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.