NCB Proximal Humerus Surgical Technique System

2016-03-31

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NCB® Proximal

Humerus

System

Surgical Technique

NCB® Proximal Humerus System – Surgical Technique

Surgical Technique

NCB Proximal Humerus

System

Table of Contents

Introduction 4

Cable Fixation Options 5

System Features 7

Indications 9

Contraindications 9

Fracture Classifications 9

Preoperative Planning and Patient Positioning 9

Sample Cases 10

Open Technique (Deltoid Pectoral Incision)

Deltoid Pectoral Incision 11

Insertion of the NCB-PH Plate and Fracture Reduction 11

NCB Screw Placement 13

Proximal  3.5 mm Locking Screw Placement (optional) 16

T-Minus Plate (optional) 19

Bone Spacer (optional) 21

Blind Screw Inserts and Sutures (optional) 21

MIS Technique*

(High Anterior/Lateral Deltoid Split Incision)

High Anterior/Lateral Deltoid Split Incision 22

Targeting Device 23

Insert the NCB-PH Plate 24

NCB Cannulated Screw Placement 25

Implant Removal 30

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

4NCB® 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.

An additional extension T-minus plate

can be assembled with cerclage wire

technique for fixation of AP lesser

tuberosity fractures.

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 con-

tact between the plate and the bone

surface reducing the risk of periosteal

blood supply impairment.

Materials: NCB plates and screws and 3.5 mm lock-

ing 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.

4-, 5- and 7-holes NCB plate

Spacer 1 to 3 mm Blind screw insert

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

7-holes T-minus plate

non

contact

Polyaxial screw placement with

subsequent locking option for

optimal system stability.

Non-Contact Bridging

ostesynthesis reduces the

risk of periosteal blood

impairment.

Anatomically contoured

plate. Forged titanium

alloy for better mechanical

strength.

4 Nm

Fastening torque

Angular stability of one NCB

locked screw

N (Newton)

(SD ±6 N)

150

Locking cap  8 mm

NCB® Proximal Humerus – 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

Proximal Humerus System.

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

more specific instructions.

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.

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.

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 Assembly Cerclage,

1.8mm

• Sterile

• Material: CoCr

REF 00-2232-002-28

REF 00-2232-004-18

Cable Fixation with

Hex Button

Cable Fixation Options Cable Fixation with

Cable Button

6NCB® Proximal Humerus – Surgical TechniqueNCB® Proximal Humerus System – Surgical Technique

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 Cannulation for 1.6 mm

Guide Wire

Cancellous bone thread

Fully threaded

cancellous screws

The NCB instrumentation is based on

well-known standard surgical tech-

niques and osteosynthesis instruments.

The NCB-PH plate can be applied in the

MIS* technique using a fully radiolucent

targeting device and can nu lated

cortical and cancellous screws with

cannulated instruments.

MIS radiolucent targeting device

MIS technique with a fully radiolucent

targeting device

 4.0 mm NCB cannulated screw

 4.5 mm NCB cannulated

cancellous screw

*MIS Minimally Invasive Solutions™ Technique by Zimmer

Targeting device and plate assembly

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

8NCB® Proximal Humerus – Surgical TechniqueNCB® Proximal Humerus System – Surgical 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® Proximal Humerus – Surgical TechniqueNCB® Proximal Humerus System – Surgical Technique

Fracture Classifications

Indications for Open Technique

(Deltoid Pectoral Incision)

• Neer classification: 2-, 3-, 4-part

displaced fractures (anatomical neck,

surgical neck, tuberculum majus,

tuberculum minus and head splitting).

• AO classification: type 11 A, extracap-

sular, 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, extracap-

sular, 2 fragments.

Preoperative Planning

and Patient Positioning

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 antero-

posterior 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.

Indications

The NCB Polyaxial Locking Plate System

is indicated for temporary internal

fixation and stabilization of fractures

and osteotomies of long bones.

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.

X ray template REF 06.01511.000

30°–45°

Patient positioning

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

30°

X ray directions

Sample Cases

Preoperative Postoperative, MIS* operation technique

Preoperative Postoperative, open operation technique

*MIS Minimally Invasive Solutions™ Technique by Zimmer

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

Insertion of NCB-PH Plate

and Fracture Reduction

Due to the anatomical contour, NCB

plates may act as a lateral guide for frac-

ture 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 attach-

ment 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.

Note: The plate should not be bent, as

this might disrupt the function of the

locking mechanism.

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

Insert the plate before

fracture reduction

12 NCB® Proximal Humerus – Surgical TechniqueNCB® Proximal Humerus System – Surgical 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.

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.

Insert the distal screw closest

to the fracture line

Use the plate for fracture reduction

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

Possible range of screw angulation

in NCB plate holes.

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.

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 Drill

REF 02.00024.118 REF 103.25.180

 3.3 mm  2.5 mm

Drill guide Drill guide

REF 02.00024.111 REF 02.00024.010

 3.3 mm  2.5 mm

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.

* 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.

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

a) Proximal screw placement

When drilling the proximal screw holes,

the use of an image inten sifier is recom-

mended. Stop approximately 5 mm

before the subchondral bone.

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.

The screw length is measured with the

NCB depth gauge (REF 02.00024.214).

The appropriate screw length is chosen

from the screw rack.

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.

Exact screw setting with the

drill guide and drill

Measuring screw length

with the depth gauge

Insert the self-tapping screw

30°

NCB® Proximal Humerus – Surgical TechniqueNCB® Proximal Humerus System – Surgical 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.

3. Add Locking Caps

To achieve angular stability, insert NCB

locking caps (REF 02.0x150.300) for

all screws with the

NCB

torque screw-

driver (REF 02.00024.022) until the

wrench declutches (clicking sound).

Note: Always use the

NCB

torque screw-

driver to tighten the locking caps and

make sure not to tilt the screwdriver dur-

ing its use. Failure to do so could dam-

age the hex drive of the locking cap and

might complicate later removal of the

implant. Bone spacers can be removed

and replaced with screws.

Insert the distal self-tapping screws

M8 locking cap placement,

tighten until wrench declutches

(click sound)

Final placement

16 NCB® Proximal Humerus – Surgical TechniqueNCB® Proximal Humerus System – Surgical 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® Proximal Humerus – Surgical TechniqueNCB® Proximal Humerus System – Surgical 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-

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.

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

T-Minus Plate (optional)

1. Apply T-Minus Plate

For lesser tuberosity fractures it is

pos si ble 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 assem-

bled 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.

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.

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

Drilling with a

standard double-drill guide

Apply T-minus plate to the bone

20 NCB® Proximal Humerus – Surgical TechniqueNCB® Proximal Humerus System – Surgical 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.

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.

Standard cerclage wire

technique is used

Cut off the remaining

cerclage wire

Applied T-minus plate and final

construct

NCB® Proximal Humerus – Surgical Technique

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.

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.

NCB® Proximal Humerus System – Surgical Technique

NCB blind screw insertion

Oblique holes 2 mm for sutures proximally

Bone spacer 2 mm (blue) proximally and distally

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 screw-

driver 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 red 1 mm

02.0x150.312 blue 2 mm

02.0x150.313 green 3 mm

22 NCB® Proximal Humerus – Surgical TechniqueNCB® Proximal Humerus System – Surgical 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.

1. Reduce the Fracture

Reduce the fracture and check under

image intensification.

The humeral head and tuberosity

fragments may be manipulated and

tem porary 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.

Incision for MIS technique

* MIS Minimally Invasive Solutions Technique by Zimmer

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

NCB screw hole numbering system

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).

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:

Note: The plate should not be bent

since this might compromise the

function of the locking mechanism.

Assembly of the targeting device

24 NCB® Proximal Humerus – Surgical TechniqueNCB® Proximal Humerus System – Surgical 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.

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.

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 arrow-

head markings.

Insert the plate

Plate alignment 10 mm distal of edge greater

tuberosity and center against the lateral aspect

Yellow arrowhead

markings

Assemble the targeting module

*MIS Minimally Invasive Solutions™ Technique by Zimmer

NCB® Proximal Humerus – Surgical 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 assem-

bly 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).

NCB® Proximal Humerus System – Surgical Technique

MIS* Technique

NCB Self-Drill Screw and Drill Dimensions

Guide wire

REF 02.01362.116

 1.6 mm

L 190 mm

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

*MIS Minimally Invasive Solutions™ Technique by Zimmer

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

Insert  1.6 mm guide wire

Find the distal center

Threaded part

to connect to

the NCB plate

Temporary plate fixation and placement

of the tissue protection sleeve

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.

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.

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.

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

Insert the cannulated

self-drilling screw

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 measur-

ing device wire is measured.

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 screw-

driver, 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.

The NCB screws should be tightened

moderately to the bone.

Note: For adequate stable fixation,

bicortical screw insertion is recom-

mended.

Determine the screw length with

the scale on the drill bit shaft

Determine the screw length with

the depth gauge

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

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.

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.

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 screw-

driver 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.

Insert the guide wire

Measuring screw length

Tighten the locking caps with

the NCB torque screwdriver

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

Use the cannulated hexagonal screw-

driver, hex 3.5 mm (REF 02.00024.120)

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.

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 screw-

driver 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 com-

plicate

later extraction of the implant.

Tighten the locking caps

with the torque screwdriver

Insert the cannulated self-drilling

cancellous screw

30 NCB® Proximal Humerus – Surgical Technique

Position of the targeting module

to place screw no. 3

No. 3

NCB® Proximal Humerus System – Surgical 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.

Implant Removal

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.

Turn the targeting module upside down

and use the yellow top marking with

hole no. 3

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

NCB Proximal Humerus – Information

Implants

NCB® Locking cap

 mm mm Quantity* REF (Non Sterile) REF (Sterile)

8 3.5 10 02.03150.300 02.02150.300

NCB® Blind screw

Quantity* REF (Non Sterile) REF (Sterile)

2 02.03150.310 02.02150.310

NCB® Spacer

(red, blue, green)

L mm mm Quantity* REF (Non Sterile) REF (Sterile)

1 3.5 – 02.03150.311 02.02150.311

2 3.5 2 02.03150.312 02.02150.312

3 3.5 – 02.03150.313 02.02150.313

L4.2

M 8 x 0.75

3.9

M 8 x 0.75

*Indicates the quantity of non sterile items in the standard graphic case.

** Not available in all countries.

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

Sterile packed

NCB®-PH plate

Holes L mm Quantity* REF (Sterile)

4 80 1 02.02262.104

5 93 1 02.02262.105

7 117 1 02.02262.107**

32 NCB® Proximal Humerus – Surgical Technique

NCB® screw, self-tapping

L mm  mm mm Quantity* REF (Non Sterile) REF (Sterile)

14 4 3.5 – 02.03155.014 02.02155.014

16 4 3.5 – 02.03155.016 02.02155.016

18 4 3.5 – 02.03155.018 02.02155.018

20 4 3.5 2 02.03155.020 02.02155.020

22 4 3.5 2 02.03155.022 02.02155.022

24 4 3.5 2 02.03155.024 02.02155.024

26 4 3.5 2 02.03155.026 02.02155.026

28 4 3.5 2 02.03155.028 02.02155.028

30 4 3.5 2 02.03155.030 02.02155.030

32 4 3.5 2 02.03155.032 02.02155.032

34 4 3.5 2 02.03155.034 02.02155.034

36 4 3.5 2 02.03155.036 02.02155.036

38 4 3.5 2 02.03155.038 02.02155.038

40 4 3.5 2 02.03155.040 02.02155.040

42 4 3.5 2 02.03155.042 02.02155.042

44 4 3.5 2 02.03155.044 02.02155.044

46 4 3.5 2 02.03155.046 02.02155.046

48 4 3.5 2 02.03155.048 02.02155.048

50 4 3.5 2 02.03155.050 02.02155.050

55 4 3.5 – 02.03155.055 02.02155.055

60 4 3.5 – 02.03155.060 02.02155.060

65 4 3.5 – 02.03155.065 02.02155.065

NCB® Proximal Humerus System – Surgical Technique

NCB® cancellous screw, self-tapping

L mm  mm mm Quantity* REF (Non Sterile) REF (Sterile)

30 4.5 3.5 – 02.03159.030 02.02159.030

32 4.5 3.5 – 02.03159.032 02.02159.032

34 4.5 3.5 – 02.03159.034 02.02159.034

36 4.5 3.5 – 02.03159.036 02.02159.036

38 4.5 3.5 – 02.03159.038 02.02159.038

40 4.5 3.5 – 02.03159.040 02.02159.040

42 4.5 3.5 – 02.03159.042 02.02159.042

44 4.5 3.5 – 02.03159.044 02.02159.044

46 4.5 3.5 2 02.03159.046 02.02159.046

48 4.5 3.5 2 02.03159.048 02.02159.048

50 4.5 3.5 2 02.03159.050 02.02159.050

55 4.5 3.5 – 02.03159.055 02.02159.055

60 4.5 3.5 – 02.03159.060 02.02159.060

65 4.5 3.5 – 02.03159.065 02.02159.065

 6.2 4.5 3.2

1.75

* Indicates the quantity of Non Sterile implants in the standard graphic case.

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

 6.2

 4

 3.4

L1.75

NCB® Proximal Humerus – Surgical Technique

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 specific instructions.

L mm  mm REF (Non Sterile) REF (Sterile)

24 4.0 02.03162.024 02.02162.024

26 4.0 02.03162.026 02.02162.026

28 4.0 02.03162.028 02.02162.028

30 4.0 02.03162.030 02.02162.030

32 4.0 02.03162.032 02.02162.032

34 4.0 02.03162.034 02.02162.034

36 4.0 02.03162.036 02.02162.036

38 4.0 02.03162.038 02.02162.038

40 4.0 02.03162.040 02.02162.040

42 4.0 02.03162.042 02.02162.042

44 4.0 02.03162.044 02.02162.044

46 4.0 02.03162.046 02.02162.046

 3.5 mm locking screws

(Non Sterile screws are included in the set ZS02.00024.796)

L mm  mm mm Quantity*** REF (Non Sterile) REF (Sterile)

20 3.5 2.5 2 00-2369-020-35 47-2369-020-35

22 3.5 2.5 2 00-2369-022-35 47-2369-022-35

24 3.5 2.5 2 00-2369-024-35 47-2369-024-35

26 3.5 2.5 2 00-2369-026-35 47-2369-026-35

28 3.5 2.5 2 00-2369-028-35 47-2369-028-35

30 3.5 2.5 2 00-2369-030-35 47-2369-030-35

32 3.5 2.5 2 00-2369-032-35 47-2369-032-35

34 3.5 2.5 2 00-2369-034-35 47-2369-034-35

36 3.5 2.5 2 00-2369-036-35 47-2369-036-35

38 3.5 2.5 2 00-2369-038-35 47-2369-038-35

40 3.5 2.5 2 00-2369-040-35 47-2369-040-35

42 3.5 2.5 2 00-2369-042-35 47-2369-042-35

44 3.5 2.5 2 00-2369-044-35 47-2369-044-35

46 3.5 2.5 2 00-2369-046-35 47-2369-046-35

48 3.5 2.5 2 00-2369-048-35 47-2369-048-35

50 3.5 2.5 2 00-2369-050-35 47-2369-050-35

 6.2 3.5 2.74

1.0 0.5

∅ 4∅ 6,2

Compatible Zimmer Products with the NCB Proximal Humerus 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, Drive Material: C.P. Titanium

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

00-2232-004-18 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

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

Graphic Case for Open Technique

NCB®-PH graphic case

module implants

Quantity* REF

1 02.00024.764

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 insert1)

(empty)

Quantity* REF

– 02.00024.766

NCB®-PH standard graphic case for open

technique (with standard instruments)

Unit REF

1 ZS02.00024.760

*Indicates the quantity in the standard graphic case.

1) Optional insert if ordered without MIS instruments.

NCB®-PH graphic case

cover

Quantity* REF

1 02.00024.701

NCB®-PH graphic case

base (Inox)

Quantity* REF

1 02.00024.702

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

Standard Instruments

NCB® locking screw holder for 3.5 mm

hexagonal screwdriver

L mm Quantity* REF

95 1 02.00024.121

NCB®-PH jig for 3.5 mm locking screws

Quantity* REF

1 02.00024.220

NCB®-PH depth gauge

Quantity* REF

1 02.00024.214

NCB®-PH conn. screw for 02.00024.220

Quantity* REF

2 02.00024.221

NCB®-PH drill guide  for 02.00024.220

 mm Quantity* REF

2.5 2 02.00024.223

NCB®-PH tissue protection sleeve

for 02.00024.220

Quantity* REF

2 02.00024.222

Small depth gauge for 3.5 mm screws

Quantity* REF

1 02.00024.216

NCB® drill bit, with quick coupling

L mm  mm Quantity* REF

195 3.3 2 02.00024.118

NCB®-PH torque screwdriver

L mm mm Quantity* REF

245 3.5 1 02.00024.022

Self-holding screw forceps

Quantity* REF

1 100.90.005

*Indicates the quantity in the standard graphic case.

NCB® drill guide

 mm Quantity* REF

2.5 1 02.00024.010

3.3 1 02.00024.111

Small hexagonal screwdriver

L mm mm Quantity* REF

245 2.5 1 109.01.020

Two-fluted drill bit  2.5 mm

L mm Quantity* REF

180 2 103.25.180

Kirschner wire, with threaded tip

L mm  mm Quantity* REF

150 2.0 4 299.20.150

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

NCB® cannulated screw

 4, self-drill

L mm  mm Quantity** REF (Non Sterile) REF (Sterile)

14 4 – 02.03157.014 02.02157.014

16 4 – 02.03157.016 02.02157.016

18 4 – 02.03157.018 02.02157.018

20 4 2 02.03157.020 02.02157.020

22 4 2 02.03157.022 02.02157.022

24 4 2 02.03157.024 02.02157.024

26 4 2 02.03157.026 02.02157.026

28 4 2 02.03157.028 02.02157.028

30 4 2 02.03157.030 02.02157.030

32 4 2 02.03157.032 02.02157.032

34 4 2 02.03157.034 02.02157.034

36 4 2 02.03157.036 02.02157.036

38 4 2 02.03157.038 02.02157.038

40 4 2 02.03157.040 02.02157.040

42 4 2 02.03157.042 02.02157.042

44 4 2 02.03157.044 02.02157.044

46 4 2 02.03157.046 02.02157.046

48 4 2 02.03157.048 02.02157.048

50 4 2 02.03157.050 02.02157.050

55 4 – 02.03157.055 02.02157.055

60 4 – 02.03157.060 02.02157.060

65 4 – 02.03157.065 02.02157.065

NCB® cannulated cancellous

screw  4.5, self-drill

L mm  mm Quantity** REF (Non Sterile) REF (Sterile)

30 4.5 – 02.03160.030 02.02160.030

32 4.5 – 02.03160.032 02.02160.032

34 4.5 – 02.03160.034 02.02160.034

36 4.5 – 02.03160.036 02.02160.036

38 4.5 – 02.03160.038 02.02160.038

40 4.5 – 02.03160.040 02.02160.040

42 4.5 – 02.03160.042 02.02160.042

44 4.5 – 02.03160.044 02.02160.044

46 4.5 2 02.03160.046 02.02160.046

48 4.5 2 02.03160.048 02.02160.048

50 4.5 2 02.03160.050 02.02160.050

55 4.5 – 02.03160.055 02.02160.055

60 4.5 – 02.03160.060 02.02160.060

65 4.5 – 02.03160.065 02.02160.065

 6.2

 4.5

 3.2

1.75

 6.2

 4

 3.4

1.75

Implants for MIS* Surgical Technique

** Indicates the quantity of Non Sterile implants in the MIS graphic case module.

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

* MIS Minimally Invasive Solutions Technique by Zimmer

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 screw rack

Quantity** REF

1 02.00024.768

NCB®-PH graphic case

module MIS instruments

Quantity** REF

1 02.00024.767

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

NCB® Proximal Humerus System – Surgical Technique

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

NCB®-PH fixation screw for

targeting device

Quantity** REF

2 02.00024.104

NCB®-PH connection screw for

targeting device

Quantity** REF

1 02.00024.103

NCB®-PH handle for targeting device

Quantity** REF

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 MIS drill bit

L mm mm Quantity** REF

230 3.3 1 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®-PH targeting module for

targeting device

Quantity** REF

1 02.00024.202

NCB®-PH/PT measuring device for

cannulated screws

Quantity** REF

1 02.00024.219

NCB®-PH Hexagonal screwdriver

cannulated short hex

L mm mm Quantity** REF

245 3.5 1 02.00024.120

MIS Instruments

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

NCB® PH guide wire with threaded tip

L mm  mm Quantity** REF

190 1.6 10 02.01362.116

Cleaning wire  1.6 mm

Quantity* REF

1 110.06.200

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

Cortical screw, self-tapping

L mm  mm mm Quantity*** REF (Non Sterile)

20 3.5 2.5 2 02.03131.020

22 3.5 2.5 2 02.03131.022

24 3.5 2.5 2 02.03131.024

26 3.5 2.5 2 02.03131.026

28 3.5 2.5 2 02.03131.028

30 3.5 2.5 2 02.03131.030

32 3.5 2.5 2 02.03131.032

34 3.5 2.5 2 02.03131.034

36 3.5 2.5 2 02.03131.036

38 3.5 2.5 2 02.03131.038

40 3.5 2.5 2 02.03131.040

 6

 3.5

 2.5

1.25

NCB® Cerclage wire for T-minus plate

Stainless Steel

L mm  mm Quantity*** REF (Non Sterile) REF (Sterile)

115 0.8 2 02.01362.108 02.00362.108

11.5

115

 0.8

NCB® T-minus plate, 7 holes

Holes Quantity*** REF (Non Sterile) REF (Sterile)

7 1 02.03262.101 02.02262.101

17.2

1.2

T-Minus Module (optional)

Implants and instrument set (REF ZS02.00024.790)

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.

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

Countersink, for quick coupling

 3.5 and 4.0 mm

Quantity*** REF

1 108.01.035

T-handle, with quick coupling for taps

Quantity*** REF

1 100.90.210

Wire bending forceps

L mm Quantity*** REF

140 1 100.11.155

T-Minus Instruments (optional)

Double drill guides  2.5 / 3.5 / 4.0

Quantity*** REF

1 100.40.035

Wire cutter, for wire max.  1.7 mm

L mm Quantity*** REF

165 1 100.11.115

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

Tap for quick coupling

L mm l mm  mm Quantity*** REF

110 50 3.5 1 106.35.110

NCB® Proximal Humerus – Surgical Technique

X ray template REF 06.01511.000

Planning Aid

NCB® Proximal Humerus System – Surgical Technique

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

Notes

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

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

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.

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

NCB Proximal Humerus Surgical Technique System

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