NCB® Proximal Tibia System Surgical Technique Ncb

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NCB® Proximal
Tibia System

Surgical Technique

3

NCB® Proximal Tibia System– Surgical Technique

Surgical Technique

Table of Contents

NCB Locking Plate
System for Proximal
Tibia

Introduction	4
Plate Design	

5

Screw Selection	

5

Cable Fixation Options	

6

MIS Radiolucent Targeting Device	

7

System Features	

7

Indications/Contraindications	8
Fracture Classification	

Sample Cases	

8

9

Preoperative Planning and Patient Positioning	

11

Open Technique	

12

Incision	12
Fracture Reduction	

12

Optional: Bone Spacers	

12

Insertion of NCB PT Plate	

13

Insertion of NCB Screws	

13

MIS Technique* 	

18

Plate Hole Numbering System	

18

Incision and Fracture Reduction	

18

Targeting Device Assembly	

19

Insertion and Preliminary Fixation of NCB PT Plate	

19

Insertion of NCB Screws in the Proximal Area	

21

Insertion of NCB Screws in the Shaft	

22

Implant Removal	

24

Ordering Information	

25

Implants	25

*MIS Minimally Invasive Solutions™ Technique
by Zimmer

Graphic Case	

28

Standard Instruments	

29

MIS Instruments	

30

Cannulated Option (Screws and Instruments)	

32

Planning Aid 	

33

4

NCB® Proximal Tibia System – Surgical Technique

Introduction
The NCB PT (Non-Contact Bridging
for the Proximal Tibia) is an optimal
plate solution for the treatment of
complex fractures of the proximal tibia.
The system allows for polyaxial screw
placement (30°) with subsequent screw
locking. 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.

Implants are available with
2 or 3 proximal holes,
left and right. Plate length
varies from 5 to 9 shaft
holes for the 2-proximal hole
plate and between 3 and
13 shaft holes for the 3-proximal hole plate.

In the locked mode, NCB PT Plate late
acts as an internal fixator without
contact between the plate and the
bone surface reducing the risk of
periosteal blood supply impairment.
The surgical technique is based on
the well-known standard plate osteosynthesis technique which gives
to surgeon the feeling for bone quality
during drilling and tightening of the
screws. In the last step all screws can
be locked and made angularly stable.
The instrumentation includes a fully
radiolucent targeting device for a
minimally invasive surgical technique
(MIS).

Anterior

Non
contact

Posterior

Polyaxial screw placement
with subsequent locking option
for optimal system stability.
Fracture reduction with a lag
screw possible.

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

Anatomically contoured
plate.

SD±10N

225 N

Locking cap ∅ 8 mm

6 Nm
Fastening torque

Blind screw insert

Materials: NCB Plates and Screws are made
of Ti6Al4V, ISO 5832-3, ASTM F136

Spacer 1 to 3 mm

Angular stability of one NCB Locked Screw

5

NCB® Proximal Tibia System– Surgical Technique

Plate Design
Two versions of the NCB PT Plate are
available: 2-proximal and 3-proximal
holes.

6°

30°

Due to the angular freedom of the
screws the whole plateau area can
be covered with both plates. The
2-proximal holes plate is recommended
when soft tissue coverage is a greater
concern.
The 3-proximal holes plate is recommended when there is a higher concern
for supporting the tibial plateau
(e.g. severe intra-articular comminution).

2-proximal holes plate

6°

Plate head has 6˚ posterior tilt to match
the lateral tibial contour.

30°

3-proximal holes plate

Screw Selection
•	Spherical screw head with standard
3.5 mm hexagonal drive
•	Self-tapping screw tip (solid screws)
•	Self-drilling and self-tapping screw
tip (cannulated screws)
•	Double-lead thread for fast screw
insertion in cortical bone

Standard Screws
(included in the screw set)

Cannulated Screws
(option)
Cannulation for
1.6 mm K-wire

Cancellous screw ∅ 5.0 mm
self tapping, L 50–90 mm; 5 mm
L 95 & 100mm (not in set)

Cancellous screw ∅ 4.5 mm self drill
L 50–100 mm; 5 mm

Zimmer ® MotionLoc ® Screws
(option)

Cortical screw ∅ 4.0 mm
self tapping,
L 14–50 mm; 2 mm
L 50–90 mm; 5 mm
L 95 & 100mm (not in set)

Cortical screw self tapping
∅ 4 mm; L 24–46; 2 mm

6

NCB® Proximal Tibia System – Surgical Technique

Cable Fixation Options
The following products from the Zimmer®
Cable-Ready® Cable Grip ­System are
­compatible with all plates in the NCB
­Proximal Tibia System except for the
3 hole length tibial NCB plate with 3
­proximal holes (REF 02.02261.203 and
02.02261.303)**. See data sheet
REF 97-2232-015-00 for more specific
­instructions.

NCB Locking Plate
Cable Button, 2.5mm, Hex Drive
• Sterile
• Material: Ti6Al4V

Hex Button, 3.5mm
• Sterile
• Material: C.P. Titanium

Cable Assembly Cerclage,
1.8mm
• Sterile
• Material: CoCr

REF 00-2232-002-35
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.

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.

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

Instructions
To insert, use the 2.5mm hex
screwdriver to thread the cable
button into the plate hole. Do not
fully tighten to allow the slots in
the button to align with the cable.
To remove, use the 2.5mm hex
screwdriver to unthread the cable
button from the plate hole.

Cable Fixation Options

Cable Fixation with
Cable Button

* Not available in Europe, Middle East and Africa.
** The 3 hole length tibial NCB plate with 3 proximal holes (REF 02.02261.203 and 02.02261.303) is a product
of BAAT Medical BV and is distributed by Zimmer only in Europe, Middle East, and Africa.

Cable Fixation with
Hex Button

7

NCB® Proximal Tibia System– Surgical Technique

MIS Radiolucent Targeting
Device
MIS* operation technique with a
fully radiolucent targeting device.

Divergent screw alignment achieved using
the targeting device

In the metaphyseal region the targeting
device ensures divergent screw alignment for increased pull-out resistance.

System Features
•	Polyaxial screw placement with
	 subsequent locking option;
•	Anatomically contoured plate with 		
	 asymmetrical plate cross section
	 to facilitate anterolateral soft tissue 		
	coverage;
•	Plate head has 6˚ posterior tilt to 		
	 match the lateral tibial contour;
•	Placement of divergent screws to 		
	 increase pull-out resistance;
•	MIS Approach with a fully radiolucent 	
	 targeting device;
•	NCB Cancellous Screws can be used
	 as lag screws to improve fracture 		
	reduction;
•	Use of conventional plating technique;
•	Feeling of bone quality during inserting
	 and tightening of screws;
•	The 2-proximal holes tibial plate is 		
	 available in 3 lengths, from 5 holes 		
	 (132 mm) to 9 holes (212 mm);
•	The 3-proximal holes tibial plate is 		
	 available in 5 lengths, from 3 holes 		
	 (92 mm) to 13 holes (292 mm).
Note: Do not use the MIS device with the
3 hole length tibial NCB plate with 3
proximal holes (REF 02.02261.203 and
02.02261.303)**.

NCB PT Plate System

*	MIS Minimally Invasive Solutions Technique by Zimmer
**	The 3 hole length tibial NCB plate with 3 proximal holes (REF 02.02261.203 and 02.02261.303) is a product of BAAT Medical BV and is distributed by Zimmer
only in Europe, Middle East, and Africa.

8

NCB® Proximal Tibia System – Surgical Technique

Indications

Note: Be sure to check for proper Regulatory approvals in your country prior to
using any products found in this surgical
technique. Some devices may not be
­currently licensed with Health Canada.
Some device compatibilities may not
be approved for use by Health Canada.

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 Tibia plate from
the NCB Polyaxial Locking Plate System
is specifically designed for the proximal
tibia.

OTA Classification

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.

A1

A2

A3

B1

B2

B3

C1

C2

C3

Typ V

Typ VI

Fracture Classification
Comprehensive classifications for
proximal tibial fractures are the OTA
and the Schatzker classifications.
Stabilization with locking plates
is recommended for most of the 41-A
and C type of fracture according
to the OTA classification for long bone.
This includes comminuted fractures,
intra-articular and extra-articular condylar fractures.

Schatzker Classification

Typ I

Typ II

Typ III

Typ IV

9

NCB® Proximal Tibia System– Surgical Technique

Sample Cases
Case 1: 41-C1 fracture
(OTA classification)

Preoperative

Postoperative

Preoperative

Postoperative

10

NCB® Proximal Tibia System – Surgical Technique

Case 2: 41-A2 fracture
(OTA classification,
MIS surgical procedure)

Preoperative

Postoperative

11

NCB® Proximal Tibia System– Surgical Technique

Preoperative Planning
and Patient Positioning

1cm

2cm

4cm

3cm

5cm

6cm

7cm

8cm

9 cm

10 cm

30°
γ

β

α
100

4
5

30

20

5 holes

Left/ thgiR

6
8

20

30

9 holes

9
13

20

30
30

20

11

11

30

20

10

10

13 holes

9
20 cm

7

7 holes

30

20
8

30

20

7

Do not bend

30

20

5
6
15 cm

Note: Do not use the x-ray template with
the 3 hole length tibial NCB plate with 3
proximal holes (REF 02.02261.203 and
02.02261.303)**.

2

1

30

20
4

10 cm

Support the knee while allowing the
leg to move freely.

3

20

30

2
3

AP View

Lateral View

5 cm

Place the patient in a supine position.
Lower the contralateral leg slightly
to make sure that lateral and AP X ray
views can be obtained clearly.

30

20

1

ε

ε

50

δ

δ

γβα

0cm

Based on the fracture type and the
specific patient condition determine
the surgical approach (i.e., open
technique or MIS) to be performed.

Polyaxial Screw

100

50
60

50

Select the appropriate length and type
of the NCB PT Plate using X rays and the
X ray template (REF 06.01365.000).

∅5

NCB-Screws
self-tapping

100

14

∅4

0cm

20
20

Magnification
1.15:1

30

13

30

12

12

25 cm

5 cm

10 cm

15 cm

NCB®-PT Proximal Lateral Tibial Osteosynthesis Plate, with Polyaxial Locking Screws
Lit. No. 06.01365.000

+H84406013650001/$150501E15Z

These reference numbers must correspond
to those of the prostheses to be implanted.
© 2015. All rights reserved, Zimmer GmbH,
Sulzerallee 8, CH-8404 Winterthur, Switzerland

Choose plate type and length using the X ray template

**	The 3 hole length tibial NCB plate with 3 proximal holes (REF 02.02261.203 and 02.02261.303) is a product of BAAT Medical BV and is distributed by Zimmer
only in Europe, Middle East, and Africa.

12

NCB® Proximal Tibia System – Surgical Technique

Open Technique
Incision
A lateral incision is recommended for
extra-articular and laterally based
type 41-B fractures, according to the
OTA classification.
For type 41-C fractures according to
the OTA classification with a complete
articular fracture, a straight anterolateral incision or short medial and
lateral incisions are recommended.

Incision

To facilitate fracture healing do not strip
the periosteum.

Fracture Reduction
Restore the articular surface (if needed)
and reduce the fracture prior to
inserting the plate. Bone fragments
can be secured with 2.0 mm K-wires
(REF 290.20.280). Make sure that
K-wires do not interfere with the future
location of the plate and screws.
Note: Check fragment position with an
image intensifier.

Temporary stabilization of the fracture

Optional: Bone Spacers
Two bone spacers can be used in
the diaphysis to avoid contact of the
plate with the bone surface reducing
the risk of periosteal blood supply
impairment.
The spacers are available in sizes
of 1 mm, 2 mm and 3 mm
(REF 02.0x150.311 to 313).
Note: Insert adequate bone spacers into
the plate before plate insertion using a
3.5mm hex screwdriver. Spacers are
­single use only and they can be removed
after locking the screws.

3 mm

2 mm

1 mm

Use of bone spacers for non-contact bridging

Drilling of the locking
holes

13

NCB® Proximal Tibia System– Surgical Technique

Insertion of NCB PT Plate
Insert the plate (REF 02.02261.xxx)
between the anterior tibialis muscle and
the periosteum.
The plate should be placed as close
as possible to the cartilage.
Temporarily fix the plate proximally and
distally with 2.0 mm K-wires through
the small holes in the plate.

Temporarily fixation of the plate

Check the plate position and the fracture
alignment with an image intensifier in
both planes. Make sure the leg axis has
been restored.
Note: The plate is anatomically shaped.
Do not bend or contour the plate to
avoid damage of the locking mechanism.

Insertion of NCB Screws
A maximum of thirty degrees of screw
angulation is allowed in all plate holes.
Use the NCB Drill Guide to avoid excessive screw angulation with consequent
failure of the locking mechanism.
Screw Type
Cancellous	
REF 02.0x152.0xx	
5 mm	
L 50–100 mm	

Drill	
REF 103.25.180	
2.5 mm	

Cortical	
REF 02.0x155.0xx	
4 mm	
L 14–100 mm	

Use the NCB Drill Guide to avoid an inclination > 30°

Cancellous cannulated
REF 02.0x158.0xx
4.5 mm
L 50–100 mm

	
02.00024.118	
3.3 mm	
REF

02.00024.233
3.3 mm
REF

Guide Wire		
REF 02.01362.116	
		1.6 mm, L 190 mm

Note: The ∅ 4 mm NCB MotionLoc
Screws are also compatible with all
plates in the P
­ roximal Tibia Plate System
except for the 3 hole length ­tibial NCB
plates with 3 proximal holes (REF
02.02261.203 and 02.02261.303)**.
­See  Zimmer ­MotionLoc surgical technique
(REF 97-3161-002-00 or 97-3161-004-00)*
for more specific instructions.

	
Drilling

Cancellous Screws
For the 5.0 mm cancellous screws (REF 02.0x152.xxx) use the NCB Drill
Guide 2.5 mm (REF 02.00024.010). To ensure correct use of the drill
guide, press the drill guide into the plate hole in a perpendicular
position and then tilt it into the preferred position. The drill guide
needs to be in constant contact with the bottom ring of the hole.
Use the 2.5 mm drill bit (REF 103.25.180) for the 5.0 mm cancellous
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.
**	The 3 hole length tibial NCB plate with 3 proximal holes (REF 02.02261.203 and 02.02261.303) is a product of BAAT Medical BV and is distributed
by Zimmer only in Europe, Middle East, and Africa

14

NCB® Proximal Tibia System – Surgical Technique

Use the NCB Depth Gauge
(REF 02.00024.005) to determine
the appropriate screw length.

Determine screw length with the NCB Depth Gauge

Insert NCB Cancellous Screws using
the NCB PT Hexagonal Screwdriver,
(REF 02.00024.124) and apply compression if needed. Cancellous screws are
partially threaded and can be used as
lag screws.
Depending on fracture type, in the
epiphyseal and metaphyseal areas,
screws should be tightened to reduce
the fracture and obtain close contact
between the plate and the bone in order
to buttress the fracture.

Use the NCB PT Hexagonal Screwdriver to hand tighten the screw
and apply compression (if needed)

Note: Tighten the bone screws by
hand only.
Repeat this procedure to insert all the
necessary NCB Cancellous Screws.
It is recommended that the most
proximal cancellous screws be placed
parallel to the tibia plateau.

Possible setting of the most proximal cancellous screws

Check the fracture reduction, plate
position and the leg axis with an
image intensifier.
To secure the angular stability insert the
NCB Locking Caps (REF 02.03150.300)
on all the cancellous screws used. Tighten
the locking caps with the NCB Torque
Screwdriver, 6 Nm (REF 02.00024.021)
until a clicking sound is heard.
Note: Always use the torque screwdriver
to tighten the locking caps and make
sure the screwdriver is not tilted during
its usage. Failure to do so could damage
the hex drive and might complicate
extraction of the implant.
Remove the proximal K-wire.

Insert the locking caps using the NCB Torque Screwdriver
to achieve 6 Nm

NCB® Proximal Tibia System– Surgical Technique

Optional
Cannulated Cancellous Screws
NCB Cannulated Cancellous Screws
are self-drilling and self-tapping. These
screws can be precisely placed over
the NCB Guide Wire, ∅ 1.6 mm.
A cannulated drill bit can be used to
pre-drill hard cortical bone.
Insertion of the ∅ 1.6 mm NCB
Guide Wire
Use the NCB Drill Guide to avoid excessive angulation of the cannulated
screws with consequent failure of the
locking mechanism.
For the 4.5 mm cannulated cancellous
screws (REF 02.0x158.0xx) insert the
NCB PT Drill Guide ∅ 3.3/1.6 mm
(REF 02.00024.192) into the NCB Drill
Guide ∅ 3.3 mm (REF 02.00024.111).
Press the drill guide into the plate hole,
tilt it in the preferred position and insert
the NCB Guide Wire with threaded tip
(REF 02.01362.116).
Note: use only the NCB Guide Wire
(REF 02.01362.116) ∅ 1.6 mm,
L = 190 mm.
Failure to do so misleads the screw
length measurement.

Use the NCB Drill Guides to avoid an inclination 30° when inserting
the NCB 1.6 guide wire

15

16

NCB® Proximal Tibia System – Surgical Technique

Insertion of the Cannulated
Cancellous Screws
Remove the NCB Drill Guide ∅ 3.3 mm
(REF 02.00024.111) and NCB PT Drill
Guide ∅ 3.3/1.6 mm (REF 02.00024.192)
and determine the screw length from
the measurement with the NCB PH/PT
Measuring Device (REF 02.00024.219)
along the NCB Guide Wire.
For hard cortical bone it is possible to
use the ∅ 3.3 mm NCB PT Cannulated
Drill Bit (REF 02.00024.233).
Note: use the ∅ 3.3 mm NCB PT Cannulated Drill Bit (REF 02.00024.233)
only for the first lateral cortex, to make
sure that the NCB Guide Wire does
not fall out.

Measure the screw length with the
NCB PH/PT Measuring Device

Use the cannulated hexagonal screwdriver (REF 02.00024.120) to insert
the cannulated self-drilling screws over
the 1.6 mm NCB Guide Wire.
To achieve the final angular stability
remove the NCB Guide Wire and tighten
the locking cap with the torque
screwdriver 6 Nm (REF 02.00024.021)
until the clicking sound is heard.
Note: it is important to remove the NCB
Guide Wire (REF 02.01362.116) prior to
inserting the locking cap
(REF 02.0x150.300) because the axial
directions for the cannulated screws and
locking cap may be different.

Insert the cannulated screw with the
hexagonal cannulated screw driver

17

NCB® Proximal Tibia System– Surgical Technique

Cortical Screws
Bicortical insertion is recommended.
For the 4.0 mm cortical screws
(REF 02.0x155.0xx) use the NCB Drill
Guide 3.3 mm (REF 02.00024.111)
with the 3.3 mm drill bit
(REF 02.00024.118).
In case of hard cortical bone tap the
cortex with the NCB Tap
(REF 02.00024.040). Remove the
NCB Drill Guide 3.3 mm when using
the NCB Tap.
Measure the screw length and
insert NCB Cortical Screw using the
NCB Hexagonal Screwdriver
(REF 02.00024.124).
Note: Tighten the bone screws by
hand only.
Repeat this procedure to insert all the
needed NCB Cortical Screws.

Insert cortical screws

Insert the NCB Locking Caps
(REF 02.x150.300) to secure the angular
stability as described for the cancellous
screws.
Remove the distal K-wire after completing screw insertions.

Insert the locking caps using the NCB
Torque Screwdriver to achieve 6 Nm

Possible final screw setting

γ

δ

α

MIS Technique

β

NCB® Proximal Tibia System – Surgical Technique

3

2

1

ε

MIS is recommended for simple and/
or extra-articular fractures. An open
approach is recommended in the proximal area to restore the articular surface.

9 holes

9
11

10
13

8

Screw holes in the proximal and metaphyseal areas are indicated with Greek
letters (α, β, γ, δ and ε).
Screw holes in the shaft area are
indicated with Roman numbers (1 to 13
according to plate length).

7

7 holes

6

5 holes

To target the correct plate holes there
is a numbering system on the targeting
devices (REF 02.00024.08x)

5

4

Plate Hole Numbering System

13 holes

Note: Do not use the MIS device with the
3 hole length tibial NCB plate with 3
proximal holes (REF 02.02261.203 and
02.02261.303)**.

12

18

NCB Plate screw hole numbering system

Incision and Fracture Reduction
A lateral incision should start proximal
to Gerdy’s tubercle and should be
extended for about 50 mm distally.
Note: Incision length will vary according
to the type of fracture.
Reduce the fracture as described in the
open technique. Take care that K-wires
used to temporarily stabilize the fracture
do not interfere with the future plate
location.

Incision

**	The 3 hole length tibial NCB plate with 3 proximal holes (REF 02.02261.203 and 02.02261.303) is a product of BAAT Medical BV and is distributed by Zimmer
only in Europe, Middle East, and Africa.

19

NCB® Proximal Tibia System– Surgical Technique

Targeting Device Assembly
Use the NCB PT right Targeting Device
(REF 02.00024.080) for NCB PT
Right Plates (REF 02.02261.xxx) and
the NCB PT Left Targeting Device
(REF 02.00024.081) for NCB PT Left
Plates (REF 02.02261.xxx).
Center the targeting device in the
specific indentations on the plate.
Insert and screw in the NCB PT Connection Bolt (REF 02.00024.083) in the “δ”
hole of the targeting device.
Note: To guarantee accurate assembly
of the plate/targeting device, insert the
NCB PT stabilization bolt
(REF 02.00024.084) into the targeting
device hole corresponding to the last
plate hole. Screw the NCB Stabilization
Bolt into the plate and insert the safety
lock pin (REF 02.00024.076) from the
anterior side.

Connection bolt

Stabilization bolt
Safety lock pin

Assembly of the targeting device prior insertion

Once the assembly of the plate/
targeting device has been accomplished,
tighten the NCB Connection Bolt
(REF 02.00024.083) with the screwdriver.
Remove the safety lock pin and the
NCB PT Stabilization Bolt in order to
insert the plate.

Insertion and Preliminary
Fixation of NCB PT Plate
Under the image intensifier insert the
plate between the anterior tibialis
muscle and the periosteum: keep the
distal end of the plate in continuous
contact with the bone surface during
insertion.
The plate should be placed as close
as possible to the joint line.

Slide the plate between the anterior tibialis muscle
and the periosteum

20

NCB® Proximal Tibia System – Surgical Technique

Insert a 2.0 mm K-wire through one of
the small proximal holes for temporary
fixation of the plate.
Make a stab incision at the most
distal plate hole.
Insert the NCB PT Stabilization Bolt
(REF 02.00024.084), the NCB PT K-Wire
Guide (REF 02.00024.092) and the
NCB PT Trocar (REF 02.00024.093) into
the corresponding hole on the targeting
device.
Screw the NCB PT Stabilization Bolt
(REF 02.00024.084) into the plate
and insert the safety lock pin
(REF 02.00024.076) as described
previously.

Close the plate targeting device configuration to guarantee correct
correspondence between the targeting device and plate holes

Center the distal part of the plate on
the bone using the image intensifier,
remove the NCB PT Trocar and insert
a 2.0 mm K-wire to fix the plate.

Anterior

Posterior

Center the distal part of the plate

Temporary fixation of the plate

21

NCB® Proximal Tibia System– Surgical Technique

Insertion of NCB Screws
in the Proximal Area
Use the same procedure as described
in the open technique.
Repeat the procedure to insert the
appropriate number of proximal screws.
Note: Check the fracture reduction
and plate position under an image
intensifier.
Lock the screws as described in the
open technique.
Only the most proximal screws can
be inserted with open technique
when the targeting device is on.

γ

ε

δ

The screw numbered “δ” needs to
be inserted when the targeting device
is removed at the end of surgery.

β

α

Use the drill guide and drill
bit to insert cancellous screws
as described in the open
technique

5
7
8

7 holes

6

5 holes

4

3

2

1

The screw numbered “δ” can be
inserted using the corresponding hole
on the targeting device following the
procedure described below.

Screw hole numbering
system

22

NCB® Proximal Tibia System – Surgical Technique

Insertion of NCB Screws
in the Shaft
Make a stab incision to access the plate
hole and insert the tissue protection
sleeve assembly (REF 02.00024.090 to
093).
Screw the NCB PT Drill Guide
(REF 02.00024.091) into the plate and
then the NCB PT soft tissue protection
sleeve (REF 02.00024.090) into the
targeting device.

Insert the tissue protection sleeve

Remove the NCB PT Trocar and NCB PT
K-Wire Guide and insert the NCB PT
Drill Bit 3.3 mm (REF 02.00024.133)
when the 4.0 mm cortical screw is used.

Drill the screw hole in the bone shaft

Use the scale on the drill bit shaft
or the NCB PT Depth Gauge
(REF 02.00024.007) to determine the
appropriate screw length.

Alternative measuring of the screw
length with the NCB Depth Gauge

23

NCB® Proximal Tibia System– Surgical Technique

Remove the NCB PT Drill Guide and
insert the appropriate screw using
the NCB PT Hexagonal Screwdriver
(REF 02.00024.124).
Note: The screw is completely inserted
when the marker on the screwdriver
reaches the soft tissue protection sleeve.

Insert the screw in the bone shaft

Insert and tighten the locking cap
(REF 02.03150.300) with the NCB Torque
Screwdriver, 6 Nm (REF 02.00024.021)
until a clicking sound is heard.
Note: Always use the torque screwdriver
to tighten the locking caps and make
sure the screwdriver is not tilted during
its usage. Failure to do so could damage
the hex drive and might complicate
extraction of the implant.

Insert the locking caps using the NCB Torque
Screwdriver to achieve 6 Nm

Remove the NCB PT Soft Tissue Protection and insert the NCB Screw Marker
(REF 02.00024.077) to indicate that the
screw is placed and locked in the hole.
Repeat the described procedure to
insert additional screws.

Use the screw marker to indicate that the screw is inserted and
locked in the hole and proceed to insert additional screws

24

NCB® Proximal Tibia System – Surgical Technique

To place the most distal screw, exchange
the NCB Stabilization Bolt with the
NCB PT Drill Guide and protection sleeve
and follow the procedure described
above.
Unscrew the connecting bolt to remove
the targeting device.

Remove the NCB Stabilization
Bolt and insert the NCB Protection
Sleeve to insert the most distal
cortical screw

Note: when using the long plate (i.e.
13 holes) the last three distal screws
may interfere with the Superficial
Peroneal nerve. Therefore, it is recommended a slightly longer stab incision
to visualize and avoid damage to the
Superficial Peroneal nerve.

Possible final screw setting

Take care to avoid damage
of the Superficial Peroneal
nerve when using long plates

Implant Removal
To remove the NCB PT Plate, first remove
all the locking caps. Then loosen all the
NCB Bone Screws without completely
removing them (this prevents rotation of
the bone plate when removing the last
screw). Then, completely remove all the
bone screws.

Removal Tips
•	Re-assemble the NCB Targeting
	 Device to remove the shaft screws
	 if the MIS approach was used
	 for implantation. The targeting device 	
	 ensures that the axial direction used 	
	 during implantation is considered.

Note: make sure that the tip of the
NCB PT Screwdriver (REF 02.00024.124)
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.

•	In case of difficulties in loosing the 		
	 NCB Screws, tighten the screws slightly 	
	 before loosening them.

25

NCB® Proximal Tibia System– Surgical Technique

Ordering Information – Implants

NCB® PT 2-proximal hole plate set
			
REF
			 ZS 02.00024.820
sterile-packed

NCB® PT 3-proximal hole plate set
			
REF
			
ZS 02.00024.830
sterile-packed

Quantity*	Holes	mm	

Quantity*	Holes	mm	

Side	 REF

Side	 REF

1	
1	
1	

5	 132	left	 02.02261.105
7	 172	left	 02.02261.107
9	 212	left	 02.02261.109

1	
1	
1	

5		132	left	 02.02261.305
7		172	left	 02.02261.307
9		212	left	 02.02261.309

1	
1	
1	

5	
7	
9	

1	
1	
1	

5		 132	 right	02.02261.205
7		 172	 right	02.02261.207
9		 212	 right	02.02261.209

132	 right	02.02261.005
172	 right	02.02261.007
212	 right	02.02261.009

NCB® PT 3-proximal hole plate (optional)
3 and 13 hole lengths
sterile-packed
Quantity*	Holes	mm	

Side	 REF

–	
–	
–	
–	

left	 02.02261.303 **
right	 02.02261.203 **
left	 02.02261.313
right	 02.02261.213

3		
3		
13		
13		

92	
92	
292	
292	

Materials: NCB Plates and Screws are made
of Ti6Al4V, ISO 5832-3, ASTM F136
*	 Indicates the quantity in the plate sets.
**	The 3 hole length tibial NCB plate with 3 proximal holes (REF 02.02261.203 and 02.02261.303) is a product of BAAT Medical BV and is distributed by Zimmer only
in Europe, Middle East, and Africa.

NCB® Proximal Tibia System – Surgical Technique

NCB® Blind Screw Insert

3.9

NCB® Locking Cap

M8 × 0.75

Quantity*	

∅ mm	

15	

8	

mm	

REF (Non Sterile)	

3.5	

Quantity*	

∅ mm	

5	

8	

mm	

REF (Non Sterile)	

3.5	

REF (Sterile)

02.03150.310	02.02150.310

NCB® Screw, self-tapping
4.2

NCB® Spacer
(red, blue, green)

REF (Sterile)

02.03150.300	02.02150.300

∅ 3.4

∅ 6.2

∅4

L

26

M8 × 0.75

Quantity*	 L mm	

2	
2	
2	

mm	 Color	

REF (Non Sterile)	

1	 3.5	red	 02.03150.311	02.02150.311
2	 3.5	blue	 02.03150.312	02.02150.312
3	 3.5	 green	02.03150.313	 02.02150.313

NCB® Cancellous Screw, thread length 32mm
∅ 4.2 ∅ 6.2

∅5
∅ 2.9
1.75
32
L

Quantity*	 L mm	

2	
2	
3	
3	
3	
3	
3	
2	
2	
–	
–	

∅ mm	

mm	 REF (Non Sterile)	

L

REF (Sterile)

REF (Sterile)

50	 5.0	3.5	 02.03152.050	02.02152.050
55	 5.0	3.5	 02.03152.055	02.02152.055
60	 5.0	3.5	 02.03152.060	02.02152.060
65	 5.0	3.5	 02.03152.065	02.02152.065
70	 5.0	3.5	 02.03152.070	02.02152.070
75	 5.0	3.5	 02.03152.075	02.02152.075
80	 5.0	3.5	 02.03152.080	02.02152.080
85	 5.0	3.5	 02.03152.085	02.02152.085
90	 5.0	3.5	 02.03152.090	02.02152.090
95	 5.0	 3.5	 02.03152.095	 02.02152.095
100	5.0	 3.5	 02.03152.100	 02.02152.100

Materials: NCB Plates and Screws are made
of Ti6Al4V, ISO 5832-3, ASTM F136
*	Indicates the quantity of non sterile implants in the standard graphic case.

Quantity*	L mm	

∅ mm	

2	
2	
2	
2	
2	
2	
2	
2	
2	
2	
4	
4	
4	
4	
4	
4	
2	
2	
2	
2	
2	
2	
2	
2	
2	
2	
2	
–	
–	

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

14	
16	
18	
20	
22	
24	
26	
28	
30	
32	
34	
36	
38	
40	
42	
44	
46	
48	
50	
55	
60	
65	
70	
75	
80	
85	
90	
95	
100	

1.75

mm	 REF (Non Sterile)	

3.5	
3.5	
3.5	
3.5	
3.5	
3.5	
3.5	
3.5	
3.5	
3.5	
3.5	
3.5	
3.5	
3.5	
3.5	
3.5	
3.5	
3.5	
3.5	
3.5	
3.5	
3.5	
3.5	
3.5	
3.5	
3.5	
3.5	
3.5	
3.5	

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	
02.03155.070	
02.03155.075	
02.03155.080	
02.03155.085	
02.03155.090	
02.03155.095	
02.03155.100	

REF (Sterile)

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
02.02155.070
02.02155.075
02.02155.080
02.02155.085
02.02155.090
02.02155.095
02.02155.100

NCB® Proximal Tibia System– Surgical Technique

Compatible Zimmer Products with the NCB Proximal Tibia System** (optional)

NCB® MotionLoc® Screws, Ø 4.0mm Cortical,
Self Tapping, Ti6Al4V
∅4

∅ 6,2

L

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

Cable Fixation Options
REF (Sterile)	

Description

47-2232-060-00*	
47-2232-060-01	
00-2232-002-35	
00-2232-004-28	
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, Material: C.P. Titanium
Cable-Ready Cable Assembly Cerclage, ∅ 1.8mm, L 914mm, Material: CoCr
Cable-Ready Cable Assembly Cerclage, ∅ 1.8mm, L 635mm, Material: CoCr

Materials: NCB Plates and Screws are made
of Ti6Al4V, ISO 5832-3, ASTM F136
* 	 Not available in Europe, Middle East and Africa.
** 	The MotionLoc screws and Cable Fixation options are compatible with all plates in the NCB Proximal Tibia System
except for the 3 hole length tibial NCB plate with 3 proximal holes (REF 02.02261.203 and 02.02261.303)
*** 	The 3 hole length tibial NCB plate with 3 proximal holes (REF 02.02261.203 and 02.02261.303) is a product of
BAAT Medical BV and is distributed by Zimmer only in Europe, Middle East, and Africa.

27

28

NCB® Proximal Tibia System – Surgical Technique

Graphic Case

NCB® PT Standard Graphic Case
for open technique; includes
REF 02.00024.801/.802/.803/.804/
.805
	REF

with content	
empty	

NCB® PT Graphic Case, module
instruments

NCB® PT Graphic Case, module
screw rack

	REF

	REF

	02.00024.803

	02.00024.805

ZS 02.00024.800
ZS 02.00024.810

NCB® PT Graphic Case, module
cannulated screws and implants

NCB® PT Graphic Case, lid

	REF

	02.00024.801

	REF

	02.00024.804
NCB® PT Graphic Case base (Inox)
	
REF
	02.00024.802

29

NCB® Proximal Tibia System– Surgical Technique

Standard Instruments

NCB® Drill Bit, with quick coupling
Quantity*	

∅ mm	

L mm	

REF

1	195	
4.3	02.00024.002

NCB® Depth Gauge
Quantity*	 L mm	 ∅ mm	

REF

1	110	
5.0/4.5/4.0	02.00024.005

NCB® Drill Guide 4.3 screws 5.0

NCB® Torque Screwdriver, 6 Nm

Quantity*	

mm	

Quantity*	

1	

4.3	02.00024.011

REF

NCB® PT Tab 4 mm, with quick
coupling
Quantity*	

mm	

1	

4.0	02.00024.040

REF

NCB® PT Hexagonal Screwdriver, shaft
Quantity*	 L mm	
mm	
REF
1	 –	 3.5	02.00024.027

L mm	

∅ mm	

REF

1	280	
3.5	02.00024.021

l mm	

∅ mm	 REF

L mm	

1	

180	154	2.5	103.25.180

*Indicates the quantity in the standard graphic case.

∅ mm	

1	

2.5	02.00024.010

REF

NCB® PT Hexagonal Screwdriver, long
Quantity*	 L mm	
mm	
REF
1	
275	3.5	 02.00024.124

NCB® Drill Bit, with quick coupling
Quantity*	 L mm	
mm	
REF
1	
195	3.3	 02.00024.118

Screw forceps self-holding

T-handle, with quick coupling

Quantity*	REF

Quantity*	REF

1	

1	100.90.210

100.90.005

L

Quantity*	

Quantity*	

NCB® Drill Guide ∅ 3.3 mm for
screws ∅ 4.0/4.5
Quantity* 	
∅ mm	
REF
1	 3.3	02.00024.111

l

Two-fluted drill bit, with quick coupling

NCB® Drill Guide ∅ 2.5 mm for screws
∅ 5.0 cancellous

Kirschner wire, stainless steel
Quantity*	

L mm	

mm	

REF

5	280	
2.0	290.20.280

30

NCB® Proximal Tibia System – Surgical Technique

MIS Instruments

Assembly pin
Quantity**	

	

REF

1	

	

02.00002.001

NCB® PT Graphic Case, for
MIS instruments
	

REF

with content	
ZS 02.00024.850
empty	02.00024.806

NCB® PT Depth Gauge
Quantity**	 		

REF

1			02.00024.007

Safety lock pin for targeting device
Quantity**			
REF
2			 02.00024.076

NCB® Screw Marker for targeting device
Quantity**	REF

8	

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

02.00024.077

31

NCB® Proximal Tibia System– Surgical Technique

NCB® PT Targeting Device
Quantity**	 Side	REF

1	
1	

right	02.00024.080
left	02.00024.081

NCB® PT Connection Bolt

NCB® PT Soft Tissue Protection
sleeve ∅ 10.0/8.2 mm

NCB® PT Trocar

Quantity**		

REF

2	2	

2		

02.00024.090

NCB® PT Drill Guide 8.2/5.2 mm

Quantity**		

REF

Quantity**		

REF

1		

02.00024.083

2		

02.00024.091

NCB® PT Stabilization Bolt for
targeting device

NCB® PT K-Wire Guide ∅ 5.2/2 mm
Quantity**		

REF

Quantity**		

REF

2		

02.00024.092

1		

02.00024.084

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

Quantity** 	

∅ mm	REF

02.00024.093

NCB® PT Drill Bit with quick coupling
Quantity** 	 ∅ mm	
	
REF
1	 2.5		
02.00024.125
1	 3.3		
02.00024.133
1	4.3	
	
02.00024.143

32

NCB® Proximal Tibia System – Surgical Technique

Cannulated Options (Screws and Instruments)

Cannulated Screws and Instrument Set 	
	
REF
	
ZS 02.00024.840
NCB® PH Guide Wire with threaded tip
Quantity***	 L mm	
mm	
REF
5	
190	 1.6	
02.01362.116

NCB® Cannulated Cancellous Screw
∅ 4.5 mm, self-drill 24 mm thread length
∅ 3.2
∅ 1.75

∅ 4.5

NCB® PH/PT Measuring Device for
cannulated screws
Quantity***	
REF
1	02.00024.219

∅ 6.2

∅ 3.5
1.75
24

Quantity***	 L mm	

2	
2	
3	
3	
3	
3	
3	
2	
2	
–	
–	

∅ mm	

L

mm	 REF (Non Sterile)	

50	 4.5	3.5	
55	 4.5	3.5	
60	 4.5	3.5	
65	 4.5	3.5	
70	 4.5	3.5	
75	 4.5	3.5	
80	 4.5	3.5	
85	 4.5	3.5	
90	 4.5	3.5	
95	 4.5	3.5	
100	 4.5	3.5	

REF (Sterile)

02.03158.050	 02.02158.050
02.03158.055	 02.02158.055
02.03158.060	 02.02158.060
02.03158.065	 02.02158.065
02.03158.070	 02.02158.070
02.03158.075	 02.02158.075
02.03158.080	 02.02158.080
02.03158.085	 02.02158.085
02.03158.090	 02.02158.090
02.03158.095		 –
02.03158.100		 –

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

NCB® PT Cannulated Drill Bit with
quick coupling
Quantity***		
∅ mm	
REF
1	
	
3.3	
02.00024.233

NCB® PT Drill Guide 3.3/1.6 mm
Materials: NCB Plates and Screws are made
of Ti6Al4V, ISO 5832-3, ASTM F136

*** 	Indicates the quantity of instruments / non sterile implants included in the Ref. Number ZS 02.00024.840

Quantity***		

REF

2	

02.00024.192

	

33

NCB® Proximal Tibia System– Surgical Technique

Planning Aid

1cm

2cm

4cm

3cm

5cm

6cm

7cm

8cm

9 cm

10 cm

γ

β

100

α

30°

Polyaxial Screw

60

50

100

50

∅5

NCB-Screws
self-tapping

100

14

∅4

0cm

1
2

5 holes

Left/ thgiR

6
9 holes

9
13

20

30
30

20

11

11

30

20

10

10

13 holes

9

30

20

8

7

7 holes

8

30

20

7

15 cm

Do not bend

30

20

6

30

20

5

5

30

20

10 cm

20 cm

3
4

4

20

30

3

AP View

20

30

2

5 cm

Lateral View

30

20

1

ε

ε

50

δ

δ

γβα

0cm

20
20

Magnification
1.15:1

30

13

30

12

12

25 cm

5 cm

10 cm

NCB®-PT Proximal Lateral Tibial Osteosynthesis Plate, with Polyaxial Locking Screws
Lit. No. 06.01365.000

+H84406013650001/$150501E15Z

X ray template

These reference numbers must correspond
to those of the prostheses to be implanted.
© 2015. All rights reserved, Zimmer GmbH,
Sulzerallee 8, CH-8404 Winterthur, Switzerland

REF 06.01365.000

15 cm

34

NCB® Proximal Tibia System – Surgical Technique

Notes

NCB® Proximal Tibia System– Surgical Technique

35

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. 06.01369.022 – Ed.2015-08

Copyright 2015 by Zimmer GmbH Subject to change without notice

Disclaimer



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