NCB Proximal Humerus Surgical Technique System

2016-03-31

: Pdf Ncb Proximal Humerus System Surgical Technique NCB_Proximal_Humerus_System_Surgical_Technique 3 2016 pdf

Open the PDF directly: View PDF .
Page Count: 44

Download
Open PDF In Browser	View PDF

NCB® Proximal
Humerus
System
Surgical Technique

NCB® Proximal Humerus System – Surgical Technique

Surgical Technique
NCB Proximal Humerus
System

Table of Contents
Introduction

Cable Fixation Options

System Features

Indications

Contraindications

Fracture Classifications

Preoperative Planning and Patient Positioning

Sample Cases

Open Technique (Deltoid Pectoral Incision)
Deltoid Pectoral Incision
Insertion of the NCB-PH Plate and Fracture Reduction
NCB Screw Placement
Proximal  3.5 mm Locking Screw Placement (optional)
T-Minus Plate (optional)
Bone Spacer (optional)
Blind Screw Inserts and Sutures (optional)

11
11
13
16
19
21
21

MIS Technique*
(High Anterior/Lateral Deltoid Split Incision)
High Anterior/Lateral Deltoid Split Incision
Targeting Device
Insert the NCB-PH Plate
NCB Cannulated Screw Placement

Implant Removal

22
23
24
25

NCB Proximal Humerus – Information
Implants 31
Graphic Case for Open Technique
34
Standard Instruments
34
Implants for MIS Surgical Technique
36
Graphic Case for MIS Technique
37
MIS Instruments
38
T-Minus Module (optional)
39
T-Minus Instruments (optional)
40
Planning Aid
41

*MIS Minimally Invasive Solutions™ Technique by Zimmer

NCB® Proximal Humerus System – Surgical Technique

Introduction
NCB Proximal Humerus
Osteosynthesis Plate
Solution for Proximal Humerus
Fractures
The NCB-PH (Non-Contact Bridging for
the Proximal Humerus) system is
an optimal solution for the treatment of
complex fractures of the proximal
humerus.
7-holes T-minus plate

An additional extension T-minus plate
can be assembled with cerclage wire
technique for fixation of AP lesser
tuberosity fractures.

4-, 5- and 7-holes NCB plate

The system allows for polyaxial screw
placement (30°) with subsequent screw
locking 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-PH plate
acts as an internal fixator without contact between the plate and the bone
surface reducing the risk of periosteal
blood supply impairment.

non
contact

Polyaxial screw placement with
subsequent locking option for
optimal system stability.

Locking cap  8 mm

Non-Contact Bridging
ostesynthesis reduces the
risk of periosteal blood
impairment.

Spacer 1 to 3 mm

Anatomically contoured
plate. Forged titanium
alloy for better mechanical
strength.

Blind screw insert

N (Newton)

(SD ±6 N)

150

4 Nm
Fastening torque

Angular stability of one NCB
locked screw
Materials: NCB plates and screws and 3.5 mm locking screws are made of Ti6Al4V, ISO 5832-3, ASTM
F136; the tuberculum minus plate is made of C.P.
titanium, ISO 5832-2, ASTM F67. The self tapping
cortical screw is made of Ti6Al7Nb, ISO 5832-11,
ASTM F1295.

Self-tapping screws:
 3.5 mm cortical screws L= 20–40 mm
 3.5 mm locking screws L= 20–50 mm
 4.0 mm NCB screws L= 14–65mm
 4.5 mm NCB cancellous screws L= 30–65mm
 4.0 mm NCB MotionLoc® screws L= 24–46mm

NCB® Proximal Humerus – Surgical Technique

Cable Fixation Options
The following products from the Zimmer®
Cable-Ready® Cable Grip
System are compatible with the NCB
Proximal Humerus System.
See data sheet REF 97-2232-015-00 for
more specific instructions.

NCB Locking Plate
Cable Button, 2.5mm, Hex Drive

Hex Button, 3.5mm

Cable Assembly Cerclage,
1.8mm

• Sterile
• Material: Ti6Al4V

• Sterile
• Material: C.P. Titanium

• Sterile
• Material: CoCr

REF 47-2232-060-00 Color: Gold*
REF 47-2232-060-01 Color: Blue

REF 00-2232-002-35

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

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.

Cable Fixation Options

* Not available in Europe, Middle East, and Africa

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.

Note: The Hex button is incom
patible with the 2.5 mm Hex
of the 3.5 mm locking screws
(REF 00-2369-0xx-35 and
47-2369-0xx-35) and Cortical,
self-tapping screws (REF
02.03131.0xx).

Cable Fixation with
Cable Button

Cable Fixation with
Hex Button

NCB
NCB®®Proximal
ProximalHumerus
Humerus–System
Surgical
– Surgical
Technique
Technique

The NCB instrumentation is based on
well-known standard surgical techniques and osteosynthesis instruments.
The NCB-PH plate can be applied in the
MIS* technique using a fully radiolucent
targeting device and cannulated
cortical and cancellous screws with
cannulated instruments.

MIS radiolucent targeting device
MIS technique with a fully radiolucent
targeting device

Targeting device and plate assembly

 4.0 mm NCB cannulated screw
Increased core diameter 3.3 mm

Spherical screw head with
standard 3.5 mm hexagonal drive

Self-drilling and
self-tapping screw tip
Double lead thread for fast
screw insertion for cortical
bone

 4.5 mm NCB cannulated
cancellous screw

Cancellous bone thread
Fully threaded
cancellous screws

*MIS Minimally Invasive Solutions™ Technique by Zimmer

Cannulation for 1.6 mm
Guide Wire

NCB
NCB®®Proximal
ProximalHumerus
HumerusSystem
– Surgical
– Surgical
Technique
Technique

System Features
Divergent Screw Alignment
The targeting device ensures
divergent screw alignment for
increased pull-out resistance
in the metaphyseal and diaphyseal
regions.

3.5 mm Locking Screws
In order to increase the stabilization
of the proximal humeral head, two
additional locking screws (i.e. uniaxial
locking screws) may be placed in the
proximal humeral head.
The screws are positioned in convergent
manner, in order to increase the pull-out
resistance in the humeral head.

NCB
NCB®®Proximal
ProximalHumerus
Humerus–System
Surgical
– Surgical
Technique
Technique

Oblique Holes for Sutures
Oblique holes  2 mm can be used
for sutures after plate osteosynthesis.

T-Minus Plate with Cerclage Wire
The plate is assembled to the NCB
humerus plate with a pre-bent U-shaped
cerclage wire  0.8 mm through two
holes at the side of the NCB plate.
The same plate can be used for left
and right.

NCB
NCB®®Proximal
ProximalHumerus
HumerusSystem
– Surgical
– Surgical
Technique
Technique

Indications

Fracture Classifications

The NCB Polyaxial Locking Plate System
is indicated for temporary internal
fixation and stabilization of fractures
and osteotomies of long bones.

Indications for Open Technique
(Deltoid Pectoral Incision)

Note: The NCB Proximal Humerus plate
from the NCB Polyaxial Locking Plate
System is specifically designed for the
proximal humerus.

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 material.
• Severe muscular, neural or vascular
diseases that endanger the extremities
involved.

• Neer classification: 2-, 3-, 4-part
displaced fractures (anatomical neck,
surgical neck, tuberculum majus,
tuberculum minus and head splitting).
• AO classification: type 11 A, extracapsular, 2 fragments; type 11 B, partially
intracapsular, 3 fragments; type 11 C,
– intracapsular.

Indications for MIS Technique*
(Anterior/Lateral Deltoid Split
Incision)
• Neer classification: 2-part displaced
fractures.
• AO classification: type 11 A, extracapsular, 2 fragments.

Preoperative Planning
An X ray of the injured shoulder on the
anteroposterior plane is essential for
preoperative planning. In addition, a “Y”
view, (perpendicular to the anteroposterior view of the scapula is also
required).
A CT scan can also provide information
concerning the tuberosities.
The use of the X ray template
(REF 06.01511.000) is recommended
for preoperative planning.

Positioning of the Patient
The patient is placed on the operating
table in the beachchair 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 proximal humerus.

Preoperative Planning
and Patient Positioning

30°–45°

Patient positioning

X ray template REF 06.01511.000

NCB
NCB®®Proximal
ProximalHumerus
Humerus–System
Surgical
– Surgical
Technique
Technique

30°

Sample Cases

X ray directions

Preoperative

Postoperative, MIS* operation technique

Preoperative

Postoperative, open operation technique

*MIS Minimally Invasive Solutions™ Technique by Zimmer

NCB
NCB®®Proximal
ProximalHumerus
HumerusSystem
– Surgical
– Surgical
Technique
Technique

Open Technique
Deltoid Pectoral Incision
For the open technique the delto-pectoral
incision is recommended.
Important: Care must be taken to avoid
damaging the axillary nerve and blood
supply to the bone fragments.

Deltoid pectoral incision
delto-pectoral

Insertion of NCB-PH Plate
and Fracture Reduction
Due to the anatomical contour, NCB
plates may act as a lateral guide for fracture reduction.
Insert the NCB-PH plate (REF 02.02262.10x)
before fracture reduction.
Positioning from A-P view
The plate should be placed approx.
10 mm distal to the rotator cuff attachment on the upper edge of the greater
tuberosity to avoid postoperative sub
acrominal impingement.
Positioning from lateral view
The plate should be centered against the
lateral aspect of the greater tuberosity.
Insert the plate before
fracture reduction

Note: The plate should not be bent, as
this might disrupt the function of the
locking mechanism.

NCB
NCB®®Proximal
ProximalHumerus
Humerus–System
Surgical
– Surgical
Technique
Technique

First place the distal screw closest
to the fracture line (see distal screw
placement). Tighten this screw and use
the plate for fracture reduction.

Insert the distal screw closest
to the fracture line

Place a 2 mm K-wire (REF 299.20.150)
at the proximal end of the plate and
use the plate-K-wire construct to secure
the reduction.

Complete the stabilization of the
fracture with the insertion of distal and
proximal NCB screws once good
fracture reduction has been achieved.

Use the plate for fracture reduction

NCB
NCB®®Proximal
ProximalHumerus
HumerusSystem
– Surgical
– Surgical
Technique
Technique

NCB Screw Placement
1. Screw Angulation
30° screw angulation is possible for all
the NCB holes in the plate.
The placement of NCB screws depends
on the fracture type and the achieved
reduction.
Alternatively, it is possible to use the
cannulated NCB screws.

Possible range of screw angulation
in NCB plate holes.

2. Screw and Drill Dimensions
NCB self-tapping screw
and drill dimensions

Screw Type
Screw Type
Cortical Cancellous
REF 02.0x155.0xx
REF 02.0x159.0xx
 4.0 mm
 4.5 mm
L 14–65 mm
L 30–65 mm

Drill
REF 02.00024.118
 3.3 mm

Drill
REF 103.25.180
 2.5 mm

Drill guide
REF 02.00024.111
 3.3 mm

Drill guide
REF 02.00024.010
 2.5 mm

NCB MotionLoc Screws
Zimmer MotionLoc Screw for NCB Polyaxial
Locking Plate System surgical technique
(REF 97-3161-002-00 or 97-3161-004-00)*
has specific instructions for the NCB
MotionLoc Screw.

* 97-3161-002-00 is for countries where NCB MotionLoc screws are approved to be used with only NCB plates and
97-3161-004-00 is for countries where NCB MotionLoc screws are approved to be used with both NCB as well as
NCB Periprosthetic plates. See NCB MotionLoc package insert for approved plate/MotionLoc screw combinations.

NCB
NCB®®Proximal
ProximalHumerus
Humerus–System
Surgical
– Surgical
Technique
Technique

a) Proximal screw placement
When drilling the proximal screw holes,
the use of an image intensifier is recom
mended. Stop approximately 5 mm
before the subchondral bone.

30°

For screw placement use the NCB drill
guide  2.5 mm (REF 02.00024.010) and
the two-fluted drill bit  2.5 mm
(REF 103.25.180). The drill guide allows
polyaxial screw placement. A stop is felt
at 30 degrees.

Exact screw setting with the
drill guide and drill

The screw length is measured with the
NCB depth gauge (REF 02.00024.214).
The appropriate screw length is chosen
from the screw rack.

Measuring screw length
with the depth gauge

Insert the self-tapping screw with
the NCB torque screwdriver
(REF 02.00024.022). For osteoporotic
bone use  4.5 mm NCB cancellous
screws. Repeat this procedure to place
all proximal bone screws.
Note: Hand tighten screws – do not use
power.
Important: When determing the proximal
screw length, the probability of bone
resorption and sintering at the fracture
site must be taken into account. Care
should be taken to ensure that the screw
tip is an adequate distance away from
the subchondral zone.

Insert the self-tapping screw

NCB
NCB®®Proximal
ProximalHumerus
HumerusSystem
– Surgical
– Surgical
Technique
Technique

b) Distal screw placement
Same screw placement procedure as
proximally.
For screw placement use the NCB drill
guide  3.3 mm (REF 02.00024.111)
and the NCB drill bit  3.3 mm
(REF 02.00024.118). The drill guide
allows polyaxial screw placement. A stop
is felt at 30 degrees. Insert the screw
using the NCB torque screwdriver
(REF 02.00024.022).
For optimal fixation, bicortical insertion
is recommended. Place at least 3 screws
below the fracture.
Insert the distal self-tapping screws

3. Add Locking Caps
To achieve angular stability, insert NCB
locking caps (REF 02.0x150.300) for
all screws with the NCB torque screwdriver (REF 02.00024.022) until the
wrench declutches (clicking sound).
Note: Always use the NCB torque screwdriver to tighten the locking caps and
make sure not to tilt the screwdriver during its use. Failure to do so could damage the hex drive of the locking cap and
might complicate later removal of the
implant. Bone spacers can be removed
and replaced with screws.
M8 locking cap placement,
tighten until wrench declutches
(click sound)

Final placement

NCB
NCB®®Proximal
ProximalHumerus
Humerus–System
Surgical
– Surgical
Technique
Technique

Proximal  3.5 mm
Locking Screw Placement
(optional)
Additionally, after reducing the fracture
with NCB screws, it is possible to
place  3.5 mm locking screws
(REF xx-2369-0xx-35), which are 4°
convergent, in the two proximal holes.

1. Screw and Drill Dimensions
 3.5mm locking screw
and drill dimensions

Screw Type
Cortical
REF xx-2369-0xx-35
 3.5 mm
L 20–50 mm

Drill
REF 103.25.180
 2.5 mm

Drill guide
REF 02.00024.223
 2.5 mm

Tissue protection sleeve
REF 02.00024.222

NCB
NCB®®Proximal
ProximalHumerus
HumerusSystem
– Surgical
– Surgical
Technique
Technique

2. Drill Screw Holes
Hold the NCB-PH jig (REF 02.00024.220)
on the plate and finger tighten or
use the small hexagonal screwdriver
(REF 109.01.020) to tighten moderatly
the NCB-PH connection screw
(REF 02.00024.221).

Insert the NCB-PH tissue protection sleeve
(REF 02.00024.222) and thread the NCB-PH
drill guide (REF 02.00024.223) into the
plate hole. Then use the two-fluted
2.5 mm drill bit (REF 103.25.180) to drill
the screw hole.

NCB
NCB®®Proximal
ProximalHumerus
Humerus–System
Surgical
– Surgical
Technique
Technique

3. Measure Screw Length
Remove the two-fluted drill bit  2.5 mm
(REF 103.25.180) and the NCB-PH drill
guide (REF 02.00024.223) and measure
the screw length with the small depth
gauge for the 3.5 mm screws
(REF 02.00024.216).
Important: When determing the proximal
screw length, the probability of bone
resorption and sintering at the fracture
site must be taken into account. Care
should be taken to ensure that the screw
tip is an adequate distance away from
the subchondral zone.

4. Insert the  3.5 mm
Locking Screws
Insert the appropriate  3.5 mm locking
screws (REF xx-2369-0xx-35) using
the small hexagonal screwdriver
(REF 109.01.020). Once the screw is
in place, remove the NCB-PH tissue
protection sleeve (REF 02.00024.222)
and repeat the procedure if the second
locking screw is needed. In order to
minimize the risk of failure in the screw
head hexagonal, it is recommended
to tighten these screws by hand only.

NCB
NCB®®Proximal
ProximalHumerus
HumerusSystem
– Surgical
– Surgical
Technique
Technique

T-Minus Plate (optional)
1. Apply T-Minus Plate
For lesser tuberosity fractures it is
possible to apply a small bendable
and cuttable plate with 7-holes
(REF 02.0x262.101). The plate is fixed
to the bone using  3.5 mm standard
self-tapping cortical screws
(REF 02.03131.0xx). The plate is assembled to the NCB humerus plate with a
pre-bent U-shaped cerclage wire
 0.8 mm (REF 02.0x362.108) through
two holes at the side of the NCB plate.
The same plate can be used for the left
and right humerus.

Apply T-minus plate to the bone

2. Drill Screw Holes
Use the standard double drill guide for
screws  2.5/3.5/4.0 (REF 100.40.035)
and the two-fluted drill bit  2.5 mm,
with quick coupling (REF 103.25.180) to
drill the holes.

Drilling with a
standard double-drill guide

3. Measure Screw Length
and Place Screws
Measure the appropriate screw
length with the small depth gauge, for
screws  3.5 mm (REF 02.00024.216).
Place the  3.5 mm self-tapping cortical
screw (REF 02.03131.0xx) with the small
hexagonal screwdriver (REF 109.01.020).
T-minus plate screw-placement

NCB
NCB®®Proximal
ProximalHumerus
Humerus–System
Surgical
– Surgical
Technique
Technique

4. Twist the Wire
Twist the cerclage wire with wire-bend
ing forceps (REF 100.11.155) and apply
some tension to the T-minus plate.

Standard cerclage wire
technique is used

5. Cut the Wire
Cut off the remaining cerclage wire with
a wire cutter (REF 100.11.115) and bend
it along the side of the NCB plate.

Cut off the remaining
cerclage wire

Applied T-minus plate and final
construct

NCB
NCB®®Proximal
ProximalHumerus
HumerusSystem
– Surgical
– Surgical
Technique
Technique

Bone Spacer (optional)
You may temporarily insert bone spacers
into the locking holes to avoid perios
teal blood flow impairment. Insert bone
spacer with a 3.5mm hexagonal screwdriver Three. Lengths from 1 to 3 mm are
available.
Note: The spacers are single-use only.
They can be removed after locking the
screws.
Bone Spacer
REF-No

Color Length

02.0x150.311
02.0x150.312
02.0x150.313

red
blue
green

1 mm
2 mm
3 mm

Bone spacer 2 mm (blue) proximally and distally

Blind Screw Inserts and
Sutures (optional)
NCB Blind Screw Insertion
To prevent bone ingrowth into empty
screw holes it is possible to use NCB
blind screw inserts (REF 02.0x150.310).
Insert the blind screw inserts using a
3.5 mm hexagonal screwdriver.
Note: Hand tighten only.

NCB blind screw insertion

Sutures
Oblique holes  2 mm can be used
for sutures and reattachment of the
rotator cuff after the plate has been
fixed to the bone with screws.

Oblique holes 2 mm for sutures proximally

NCB
NCB®®Proximal
ProximalHumerus
Humerus–System
Surgical
– Surgical
Technique
Technique

MIS Technique*
High Anterior/Lateral Deltoid
Split Incision
A high anterior/lateral deltoid split
incision is recommended.

Important: Care must be taken to avoid
damaging the axillary nerve and to
keep intact the blood supply of the bone
fragments.

Incision for MIS technique

1. Reduce the Fracture
Reduce the fracture and check under
image intensification.
The humeral head and tuberosity
fragments may be manipulated and
temporary fixed with 2 mm Kirschner
wires (K-wires) (REF 299.20.150). K-wires
should be placed where they will not
interfere with the plate application.
Note: If the use of the additional 3.5 mm
locking screws is required, insert
these screws after the targeting device
is removed.

* MIS Minimally Invasive Solutions Technique by Zimmer

NCB
NCB®®Proximal
ProximalHumerus
HumerusSystem
– Surgical
– Surgical
Technique
Technique

Targeting Device
Plate Hole Numbering System
To target the correct plate holes there
is a numbering system on the targeting
module (REF 02.00024.202).

Assembly of the targeting device

The top side of the targeting module
is for the screw holes with numbers:
1–2–4–5–6–7–8–9–10
Turn the targeting module upside down
for the number:
3

1
3
4
5
6
7

Note: The plate should not be bent
since this might compromise the
function of the locking mechanism.

8
9
10

NCB screw hole numbering system

NCB
NCB®®Proximal
ProximalHumerus
Humerus–System
Surgical
– Surgical
Technique
Technique

Insert the NCB PH Plate
1. Assemble the MIS* radiolucent
targeting device
Assemble the radiolucent handle
(REF 02.00024.101) to the proximal end
of the NCB-PH plate using the NCB-PH
connection screw (REF 02.00024.103).
Use a 3.5 mm hexagonal screwdriver to
tighten the connection screw.

2. Inserting NCB PH Plate
Insert the plate (REF 02.02262.10x)
through the high anterior/lateral
deltoid split incision subcutaneously
along the proximal humerus.

Insert the plate

Note: Attempt to get bone contact
immediately. Care must be taken
to avoid damaging the axillary nerve
and the vascularization of the
fragments.

3. Position NCB PH Plate to Bone
Positioning from A-P view
The plate should be placed approx.
10 mm distal to the rotator cuff
attachment on the upper edge of the
greater tuberosity to avoid postoperative
subacrominal impingement.

Plate alignment 10 mm distal of edge greater
tuberosity and center against the lateral aspect

Positioning from lateral view
The plate should be centered
against the lateral aspect of the greater
tuberosity.

4. Assemble the Targeting Module
Attach the targeting module
(REF 02.00024.202) to the handle with the
hole numbering 1–2–4–5–6–7–8–9–10
on the lateral side. Fit the yellow arrowhead markings.

Yellow arrowhead
markings
Assemble the targeting module

*MIS Minimally Invasive Solutions™ Technique by Zimmer

NCB
NCB®®Proximal
ProximalHumerus
HumerusSystem
– Surgical
– Surgical
Technique
Technique

NCB Cannulated Screw
Placement
1. General Remarks
Placement of the NCB screws depends
on the fracture type and the reduction
achieved.
Two cannulated screw types are offered
with the NCB-PH System. Cancellous
NCB screws, preferably for the epiphysis
and metaphysis, as well as cortical NCB
screws which are optimal for placement
in the diaphysis. Both screw types are
self-drilling and self-tapping. The screws
can be precisely placed over the guide
wires. A tissue protection sleeve assembly is used for guidance. A cannulated
drill bit can be used to predrill hard
cortical bone.
Note: Use the cannulated screws
only after insertion of  1.6 mm, length
190 mm guide wire (REF 02.01362.116).

*MIS Minimally Invasive Solutions™ Technique by Zimmer

MIS* Technique
NCB Self-Drill Screw and Drill Dimensions

Guide wire
02.01362.116
 1.6 mm
L 190 mm
REF

Screw Type
Screw Type
Cannulated Cannulated
Cortical, self drilling
Cancellous, self drilling
REF 02.0x157.0xx
REF 02.0x160.0xx
 4.0 mm
 4.5 mm
L 14–65 mm
L 30–65 mm

Drill
REF 02.00024.117
 3.3 mm

NCB
NCB®®Proximal
ProximalHumerus
Humerus–System
Surgical
– Surgical
Technique
Technique

2. Temporary Plate Fixation
Proximally, the plate can be temporarily
fixed to the bone with a 1.6 mm
guide wire through the NCB-PH
connection screw (REF 02.00024.103)
of the targeting device.

To fix the plate distally, insert the
NCB Tissue Protection Sleeve assembly
1.6-10 (REF 02.0024.213,
02.0024.114 to 116) through a skin
incision and screw the NCB-PH drill
guide (REF 02.00024.114) into the
plate and then the NCB-PH soft tissue
protection sleeve (REF 02.00024.213)
into the targeting device.

Threaded part
to connect to
the NCB plate

Temporary plate fixation and placement
of the tissue protection sleeve

Insert  1.6 mm guide wire with
a length of 190 mm (REF 02.01362.116)
and confirm the correct position with an
image intensifier.

Insert  1.6 mm guide wire

Note: The distal center can be found
with  1.6 mm guide wire by finding the
anterior and posterior bone cortex and
putting the guide wire in the middle of
these two reference points.

Find the distal center

NCB
NCB®®Proximal
ProximalHumerus
HumerusSystem
– Surgical
– Surgical
Technique
Technique

3. Distal Cannulated Screw Placement
Determine the screw length from the
measurement with the NCB measuring
device gauge (REF 02.00024.219) along
the  1.6 mm guide wire (L = 190 mm
only).
Note: With this procedure the distance
from the plate to the tip of the measuring device wire is measured.

Determine the screw length with
the depth gauge

For hard cortical bone it is possible
to use the  3.3 mm NCB cannulated
drill bit (REF 02.00024.117) (only until
touching the second cortex, to make
sure that the guide wire does not fall
out). If the drill bit is used, the screw
length can be determined from the
scale on the drill bit shaft.

Use the cannulated hexagonal screwdriver, hex 3.5 mm (REF 02.00024.120)
to insert the cannulated self-drilling
screw (REF 02.0x157.0xx) over the 1.6 mm
guide wire.

Determine the screw length with
the scale on the drill bit shaft

The NCB screws should be tightened
moderately to the bone.
Note: For adequate stable fixation,
bicortical screw insertion is recommended.

Insert the cannulated
self-drilling screw

NCB
NCB®®Proximal
ProximalHumerus
Humerus–System
Surgical
– Surgical
Technique
Technique

4. Achieve Angular Stability
To achieve angular stability remove the
guide wire and tighten the locking cap
(REF 02.0x150.300) with the NCB torque
screwdriver (REF 02.00024.022) until
the wrench declutches (clicking sound).
Note: Always use the NCB torque screwdriver to tighten the locking caps and
make sure not to tilt the screwdriver
during its usage.
Failure to do so could damage the hex
drive of the cap and might complicate
later extraction of the implant.

Tighten the locking caps with
the NCB torque screwdriver

5. Proximal Cannulated Screw
Placement
Insert  1.6 mm guide wire with a length
of 190 mm (REF 02.01362.116) close to
the subchondral bone and confirm the
correct position under image intensifi
cation.

Insert the guide wire

Measure the length with the NCB
measuring device (REF 02.00024.219)
along the  1.6 mm guide wire
(L = 190 mm only).
Note: With this procedure the distance
from the plate to the tip of the guide
wire is measured. Determine the screw
length by subtracting a sufficient
distance to make sure that the screw is
in an adequate distance from the joint.

Measuring screw length

NCB
NCB®®Proximal
ProximalHumerus
HumerusSystem
– Surgical
– Surgical
Technique
Technique

Use the cannulated hexagonal screwdriver, hex 3.5 mm (REF 02.00024.120)
to insert the cannulated self-drilling
cancellous screw (REF 02.0x160.0xx)
over the 1.6 mm guide wire.
The NCB screws should only be
tightened moderately to the bone.

Insert the cannulated self-drilling
cancellous screw

6. Achieve Angular Stability
To achieve angular stability, remove the
guide wire and tighten the locking cap
(REF 02.0x150.300) with the NCB torque
screwdriver (REF 02.00024.022) until the
wrench declutches (clicking sound).

Note: Always use the NCB torque screwdriver to tighten the locking caps and
make sure not to tilt the screwdriver
during its usage.
Failure to do so could damage the hex
driver of the locking cap and might complicate later extraction of the implant.

Tighten the locking caps
with the torque screwdriver

NCB
NCB®®Proximal
ProximalHumerus
Humerus–System
Surgical
– Surgical
Technique
Technique

7. Last Proximal Screw Placement (No. 3)
To place the last proximal screw, turn
the targeting module over and use hole
number 3. Fit the two yellow arrowhead
markings together. Then follow the
same screw placement procedure as
described in step 5–6.

Proximal  3.5 mm locking screw
placement
If the additional stabilization with
3.5 mm locking screws is required,
remove the targeting device and repeat
the sequence described on page 15.

Use of solid screws
If fixation with solid screws is preferred,
use the NCB-PH MIS drill bit
(REF 02.00024.215) and the NCB-PH
depth gauge (REF 02.00024.214) to drill
and measure the screw length.

Turn the targeting module upside down
and use the yellow top marking with
hole no. 3

No. 3

Implant Removal
Position of the targeting module
to place screw no. 3

To remove the NCB-PH humerus plate,
first remove the  3.5 mm locking
screws; if they were used. Then remove
all locking caps (REF 02.0x150.300)
from the plate. Loosen all bone screws
and then remove all bone screws
completely. This prevents simultaneous
rotation of the plate when removing
the last bone screw.

NCB
NCB®®Proximal
ProximalHumerus
HumerusSystem
– Surgical
– Surgical
Technique
Technique

NCB Proximal Humerus – Information

NCB® Locking cap

3.9

Implants

M 8 x 0.75

 mm

3.5

Quantity*

REF (Non Sterile)

REF (Sterile)

02.03150.300

02.02150.300

Sterile packed

NCB®-PH plate
L mm

Quantity*

4 80 1
5 93 1
7 117 1

REF (Sterile)

Quantity*

REF (Non Sterile)

REF (Sterile)

02.02262.104
02.02262.105
02.02262.107**

02.03150.310

02.02150.310

NCB® Spacer
(red, blue, green)

4.2

Holes

NCB® Blind screw

M 8 x 0.75

L mm

1
2
3

3.5
3.5
3.5

Quantity*

REF (Non Sterile)

REF (Sterile)

–
2
–

02.03150.311
02.03150.312
02.03150.313

02.02150.311
02.02150.312
02.02150.313

Materials: The NCB plates and screws are made of Ti6Al4V, ISO 5832-3, ASTM F136.

*Indicates the quantity of non sterile items in the standard graphic case.
** Not available in all countries.

NCB
NCB®®Proximal
ProximalHumerus
Humerus–System
Surgical
– Surgical
Technique
Technique

NCB® screw, self-tapping

NCB® cancellous screw, self-tapping

 3.4

4

L mm  mm

14 4
16 4
18 4
20 4
22 4
24 4
26 4
28 4
30 4
32 4
34 4
36 4
38 4
40 4
42 4
44 4
46 4
48 4
50 4
55 4
60 4
65 4

1.75

mm Quantity* REF (Non Sterile)

3.5 –
3.5 –
3.5 –
3.5 2
3.5 2
3.5 2
3.5 2
3.5 2
3.5 2
3.5 2
3.5 2
3.5 2
3.5 2
3.5 2
3.5 2
3.5 2
3.5 2
3.5 2
3.5 2
3.5 –
3.5 –
3.5 –

 3.2

 6.2

02.03155.014
02.03155.016
02.03155.018
02.03155.020
02.03155.022
02.03155.024
02.03155.026
02.03155.028
02.03155.030
02.03155.032
02.03155.034
02.03155.036
02.03155.038
02.03155.040
02.03155.042
02.03155.044
02.03155.046
02.03155.048
02.03155.050
02.03155.055
02.03155.060
02.03155.065

 4.5

 6.2

1.75

REF (Sterile)

L mm  mm

02.02155.014
02.02155.016
02.02155.018
02.02155.020
02.02155.022
02.02155.024
02.02155.026
02.02155.028
02.02155.030
02.02155.032
02.02155.034
02.02155.036
02.02155.038
02.02155.040
02.02155.042
02.02155.044
02.02155.046
02.02155.048
02.02155.050
02.02155.055
02.02155.060
02.02155.065

30 4.5 3.5
32 4.5 3.5
34 4.5 3.5
36 4.5 3.5
38 4.5 3.5
40 4.5 3.5
42 4.5 3.5
44 4.5 3.5
46 4.5 3.5
48 4.5 3.5
50 4.5 3.5
55 4.5 3.5
60 4.5 3.5
65 4.5 3.5

Materials: The NCB screws are made of Ti6Al4V, ISO 5832-3, ASTM F136.
* Indicates the quantity of Non Sterile implants in the standard graphic case.

mm Quantity* REF (Non Sterile)

–
–
–
–
–
–
–
–
2
2
2
–
–
–

02.03159.030
02.03159.032
02.03159.034
02.03159.036
02.03159.038
02.03159.040
02.03159.042
02.03159.044
02.03159.046
02.03159.048
02.03159.050
02.03159.055
02.03159.060
02.03159.065

REF (Sterile)

02.02159.030
02.02159.032
02.02159.034
02.02159.036
02.02159.038
02.02159.040
02.02159.042
02.02159.044
02.02159.046
02.02159.048
02.02159.050
02.02159.055
02.02159.060
02.02159.065

NCB® Proximal Humerus – Surgical Technique

 3.5 mm locking screws
(Non Sterile screws are included in the set ZS02.00024.796)
 2.74

 3.5

NCB® MotionLoc® Screws (optional)  4.0 mm Cortical,
Self Tapping. See surgical technique (REF 97-3161-002-00
or 97-3161-004-00)* for more s pecific instructions.

 6.2

1.0

∅4

∅ 6,2

0.5

L mm  mm

mm Quantity*** REF (Non Sterile)

20 3.5 2.5 2
22 3.5 2.5 2
24 3.5 2.5 2
26 3.5 2.5 2
28 3.5 2.5 2
30 3.5 2.5 2
32 3.5 2.5 2
34 3.5 2.5 2
36 3.5 2.5 2
38 3.5 2.5 2
40 3.5 2.5 2
42 3.5 2.5 2
44 3.5 2.5 2
46 3.5 2.5 2
48 3.5 2.5 2
50 3.5 2.5 2

REF (Sterile)

00-2369-020-35 47-2369-020-35
00-2369-022-35 47-2369-022-35
00-2369-024-35 47-2369-024-35
00-2369-026-35 47-2369-026-35
00-2369-028-35 47-2369-028-35
00-2369-030-35 47-2369-030-35
00-2369-032-35 47-2369-032-35
00-2369-034-35 47-2369-034-35
00-2369-036-35 47-2369-036-35
00-2369-038-35 47-2369-038-35
00-2369-040-35 47-2369-040-35
00-2369-042-35 47-2369-042-35
00-2369-044-35 47-2369-044-35
00-2369-046-35 47-2369-046-35
00-2369-048-35 47-2369-048-35
00-2369-050-35 47-2369-050-35

L mm  mm

REF (Non Sterile)

REF (Sterile)

24
26
28
30
32
34
36
38
40
42
44
46

02.03162.024
02.03162.026
02.03162.028
02.03162.030
02.03162.032
02.03162.034
02.03162.036
02.03162.038
02.03162.040
02.03162.042
02.03162.044
02.03162.046

02.02162.024
02.02162.026
02.02162.028
02.02162.030
02.02162.032
02.02162.034
02.02162.036
02.02162.038
02.02162.040
02.02162.042
02.02162.044
02.02162.046

4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0

Compatible Zimmer Products with the NCB Proximal Humerus System
REF Sterile

Description

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

NCB Polyaxial Locking Plate Cable Button, Gold, 2.5mm Hex Drive, Material: Ti6Al4V
NCB Polyaxial Locking Plate Cable Button, Blue, 2.5mm Hex Drive, Material: Ti6Al4V
Hex Buttons, 3.5mm Hex, Drive Material: C.P. Titanium
Cable-Ready Cable Assembly Cerclage, Ø 1.8mm, L. 914mm, Material: CoCr
Cable-Ready Cable Assembly Cerclage, Ø 1.8mm, L. 635mm, Material: CoCr

Materials: The 3.5 mm locking screws and NCB MotionLoc screws are made of Ti6Al4V, ISO 5832-3, ASTM F136.
* 97-3161-002-00 is for countries where NCB MotionLoc screws are approved to be used with only NCB plates and
97-3161-004-00 is for countries where NCB MotionLoc screws are approved to be used with both NCB as well as
NCB Periprosthetic plates. See NCB MotionLoc package insert for approved plate/MotionLoc screw combinations.
** Not available in Europe, Middle East and Africa.
*** Indicates the quantities of Non Sterile implants in the Ti 3.5 mm locking screw set ZS02.00024.796

NCB® Proximal Humerus System
– Surgical
– Surgical
Technique
Technique

Graphic Case for Open Technique
NCB®-PH standard graphic case for open
technique (with standard instruments)
Unit
REF
1
ZS02.00024.760

NCB®-PH graphic case
module instruments
Quantity*
REF
1 02.00024.763

NCB®-PH graphic case module
screw rack standard
Quantity*
REF
1 02.00024.765

NCB®-PH graphic case
cover
Quantity*
REF
1 02.00024.701

NCB®-PH graphic case
module implants
Quantity*
REF
1 02.00024.764

NCB®-PH graphic case insert 1)
(empty)
Quantity*
REF
– 02.00024.766

NCB®-PH graphic case
base (Inox)
Quantity*
REF
1 02.00024.702

*Indicates the quantity in the standard graphic case.
1) Optional insert if ordered without MIS instruments.

NCB
NCB®® Proximal
Proximal Humerus
Humerus System
– Surgical
– Surgical
Technique
Technique

Standard Instruments

Small depth gauge for 3.5 mm screws
Quantity*
REF
1 02.00024.216

Small hexagonal screwdriver
L mm
mm
Quantity* REF
245 2.5 1 109.01.020

NCB®-PH torque screwdriver
L mm
mm
Quantity* REF
245 3.5 1 02.00024.022

NCB®-PH jig for 3.5 mm locking screws
Quantity*
REF
1 02.00024.220

Two-fluted drill bit  2.5 mm
L mm
Quantity* REF
180
2 103.25.180

NCB® drill bit, with quick coupling
L mm
 mm Quantity* REF
195 3.3 2 02.00024.118

NCB®-PH conn. screw for 02.00024.220
Quantity*
REF
2 02.00024.221

Self-holding screw forceps
Quantity*
REF
1 100.90.005

NCB® locking screw holder for 3.5 mm
hexagonal screwdriver
L mm
Quantity* REF
95
1 02.00024.121

NCB®-PH tissue protection sleeve
for 02.00024.220
Quantity*
REF
2 02.00024.222

Kirschner wire, with threaded tip
L mm
 mm
Quantity*
REF
150 2.0 4
299.20.150

NCB®-PH depth gauge
Quantity*
REF
1
02.00024.214

NCB®-PH drill guide  for 02.00024.220
 mm
Quantity*
REF
2.5
2 02.00024.223

NCB® drill guide
 mm Quantity* REF

2.5
3.3

1 02.00024.010
1 02.00024.111

*Indicates the quantity in the standard graphic case.

NCB® Proximal Humerus System
– Surgical
– Surgical
Technique
Technique

Implants for MIS* Surgical Technique

NCB® cannulated screw
 4, self-drill

NCB® cannulated cancellous
screw  4.5, self-drill
 3.4  4

 3.2

 6.2

 4.5

1.75

 6.2

1.75

L mm

 mm

Quantity**

14 4 –
16 4 –
18 4 –
20 4 2
22 4 2
24 4 2
26 4 2
28 4 2
30 4 2
32 4 2
34 4 2
36 4 2
38 4 2
40 4 2
42 4 2
44 4 2
46 4 2
48 4 2
50 4 2
55 4 –
60 4 –
65 4 –

REF (Non Sterile)

REF (Sterile)

L mm

 mm

02.03157.014
02.03157.016
02.03157.018
02.03157.020
02.03157.022
02.03157.024
02.03157.026
02.03157.028
02.03157.030
02.03157.032
02.03157.034
02.03157.036
02.03157.038
02.03157.040
02.03157.042
02.03157.044
02.03157.046
02.03157.048
02.03157.050
02.03157.055
02.03157.060
02.03157.065

02.02157.014
02.02157.016
02.02157.018
02.02157.020
02.02157.022
02.02157.024
02.02157.026
02.02157.028
02.02157.030
02.02157.032
02.02157.034
02.02157.036
02.02157.038
02.02157.040
02.02157.042
02.02157.044
02.02157.046
02.02157.048
02.02157.050
02.02157.055
02.02157.060
02.02157.065

30
32
34
36
38
40
42
44
46
48
50
55
60
65

4.5 –
4.5 –
4.5 –
4.5 –
4.5 –
4.5 –
4.5 –
4.5 –
4.5 2
4.5 2
4.5 2
4.5 –
4.5 –
4.5 –

Materials: The NCB screws are made of Ti6Al4V, ISO 5832-3, ASTM F136.
* MIS Minimally Invasive Solutions Technique by Zimmer
** Indicates the quantity of Non Sterile implants in the MIS graphic case module.

Quantity**

REF (Non Sterile)

REF (Sterile)

02.03160.030
02.03160.032
02.03160.034
02.03160.036
02.03160.038
02.03160.040
02.03160.042
02.03160.044
02.03160.046
02.03160.048
02.03160.050
02.03160.055
02.03160.060
02.03160.065

02.02160.030
02.02160.032
02.02160.034
02.02160.036
02.02160.038
02.02160.040
02.02160.042
02.02160.044
02.02160.046
02.02160.048
02.02160.050
02.02160.055
02.02160.060
02.02160.065

NCB® Proximal Humerus System – Surgical Technique

Graphic Case for MIS Technique

NCB®-PH graphic case module
MIS instruments and screw rack
(with content)
Quantity**
REF
–
ZS02.00024.780

NCB®-PH graphic case
module MIS instruments
Quantity**
REF
1 02.00024.767

NCB®-PH graphic case
module MIS screw rack
Quantity**
REF
1 02.00024.768

**Indicates the quantity in the MIS graphic case module.

NCB® Proximal Humerus System
– Surgical
– Surgical
Technique
Technique

MIS Instruments

1 02.00024.101

NCB® cannulated drill bit with
quick coupling
L mm
 mm Quantity**
REF
195 3.3 1
02.00024.117

NCB®-PH/PT measuring device for
cannulated screws
Quantity**
REF
1 02.00024.219

NCB®-PH targeting module for
targeting device
Quantity**
REF
1 02.00024.202

NCB®-PH Hexagonal screwdriver
cannulated short hex
L mm
mm Quantity**
REF
245 3.5 1
02.00024.120

Cleaning wire  1.6 mm
Quantity*
REF
1 110.06.200

NCB®-PH connection screw for
targeting device
Quantity**
REF
1 02.00024.103

NCB®-PH MIS drill bit
L mm
mm Quantity**
230 3.3 1

NCB® PH guide wire with threaded tip
L mm
 mm
Quantity**
REF
190 1.6 10
02.01362.116

NCB®-PH
Quantity**

handle for targeting device
REF

NCB®-PH fixation screw for
targeting device
Quantity**
REF
2 02.00024.104

**Indicates the quantity in the MIS graphic case module.

REF

02.00024.215

NCB®-PH tissue protection sleeves
 Quantity**
REF
10/8.0 2
02.00024.213
8/3.3 2
02.00024.114
3.3/1.6 2
02.00024.115
1.6 2
02.00024.116

NCB
NCB®® Proximal
Proximal Humerus
Humerus System
– Surgical
– Surgical
Technique
Technique

T-Minus Module (optional)
Implants and instrument set (REF ZS02.00024.790)

17.2

Cortical screw, self-tapping

1.2
 3.5

 2.5

6

1.25
L

NCB® T-minus plate, 7 holes
Holes

Quantity***

REF (Non Sterile)

02.03262.101 02.02262.101

REF (Sterile)

L mm  mm

11.5

115

 0.8

NCB® Cerclage wire for T-minus plate
Stainless Steel
L mm

 mm

Quantity*** REF (Non Sterile)

115 0.8 2

Material:The self tapping cortical screw is made of
Ti6Al7Nb, ISO 5832-11, ASTM F1295.
The tuberculum minus plate is made of C.P. titanium,
ISO 5832-2, ASTM F67.
*** Indicates the quantity of Non Sterile implants in the T-minus module.

mm Quantity*** REF (Non Sterile)

20 3.5 2.5
22 3.5 2.5
24 3.5 2.5
26 3.5 2.5
28 3.5 2.5
30 3.5 2.5
32 3.5 2.5
34 3.5 2.5
36 3.5 2.5
38 3.5 2.5
40 3.5 2.5

REF (Sterile)

02.01362.108 02.00362.108

2
2
2
2
2
2
2
2
2
2
2

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

NCB® Proximal Humerus System
– Surgical
– Surgical
Technique
Technique

T-Minus Instruments (optional)

Wire cutter, for wire max.  1.7 mm
L mm
Quantity***
REF
165 1
100.11.115

Wire bending forceps
L mm
Quantity***
140 1

REF

100.11.155

Double drill guides  2.5 / 3.5 / 4.0
Quantity***
REF
1 100.40.035

L
l

Tap for quick coupling
T-handle, with quick coupling for taps
Quantity***
REF
1
100.90.210

*** Indicates the quantity in the T-minus module.

L mm

l mm

 mm Quantity*** REF

110 50 3.5 1

106.35.110

Countersink, for quick coupling
 3.5 and 4.0 mm
Quantity***
REF
1
108.01.035

NCB
NCB®® Proximal
Proximal Humerus
Humerus System
– Surgical
– Surgical
Technique
Technique

Planning Aid

X ray template

REF

06.01511.000

NCB® Proximal Humerus System
– Surgical
– Surgical
Technique
Technique

Notes

NCB
NCB®® Proximal
Proximal Humerus
Humerus System
– Surgical
– Surgical
Technique
Technique

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.

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

Lit. No. 06.01499.012 – Ed. 2015-08 ZHUB

Disclaimer

Source Exif Data:

File Type                       : PDF
File Type Extension             : pdf
MIME Type                       : application/pdf
PDF Version                     : 1.4
Linearized                      : Yes
Create Date                     : 2015:08:27 09:06:53-05:00
Creator                         : Adobe InDesign CS6 (Macintosh)
Date Released                   : 08/2015
ID                              : 06.01369.022
Modify Date                     : 2015:12:02 10:18:18-05:00
Tagged PDF                      : Yes
XMP Toolkit                     : Adobe XMP Core 5.4-c005 78.147326, 2012/08/23-13:03:03
Format                          : application/pdf
Modified                        : 2015:09:01 08:06:44.657-05:00
Subject                         : null
Title                           : NCB Proximal Humerus Surgical Technique
Size                            : 5111431
Sha 1                           : 3053c348af6cda3e49ca376701db8f71a4a9a563
Extracted                       : 2015:09:01 08:06:18.016-05:00
Metadata Date                   : 2015:12:02 10:18:18-05:00
Creator Tool                    : Adobe InDesign CS6 (Macintosh)
Rendition Class                 : proof:pdf
Document ID                     : xmp.id:786428E80E20681192B0AD786DDDDC94
Original Document ID            : adobe:docid:indd:d955edec-a028-11dd-b12a-e0c5716c4693
Instance ID                     : uuid:ccc29603-d5fc-1a40-968c-51ec97f822ec
Derived From Rendition Class    : default
Derived From Instance ID        : xmp.iid:776428E80E20681192B0AD786DDDDC94
Derived From Document ID        : xmp.did:4C90D27C512068118083C6BC5A375843
Derived From Original Document ID: adobe:docid:indd:d955edec-a028-11dd-b12a-e0c5716c4693
History Action                  : converted
History Software Agent          : Adobe InDesign CS6 (Macintosh)
History Parameters              : from application/x-indesign to application/pdf
History When                    : 2015:08:27 09:06:53.000-05:00
History Changed                 : /
Id                              : 06.01369.022
Date 0020 Released              : 0.00397022332506203
Producer                        : Adobe PDF Library 10.0.1
Trapped                         : False
Tags                            : zimmer-web:website/healthcare-professionals/surgical-techniques/trauma
Page Layout                     : TwoPageRight
Page Count                      : 44

EXIF Metadata provided by EXIF.tools

NCB Proximal Humerus Surgical Technique System

Navigation menu

Versions of this User Manual:

Views

Navigation