NCB® Proximal Tibia System Surgical Technique Ncb

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NCB® Proximal

Tibia System

Surgical Technique

NCB® Proximal Tibia System– Surgical Technique 3

Surgical Technique

NCB Locking Plate

System for Proximal

Tibia

Table of Contents

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 8

Sample Cases 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

Graphic Case 28

Standard Instruments 29

MIS Instruments 30

Cannulated Option (Screws and Instruments) 32

Planning Aid 33

* MIS Minimally Invasive Solutions™ Technique

by Zimmer

4NCB® 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.

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 osteo-

synthesis 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).

Materials: NCB Plates and Screws are made

of Ti6Al4V, ISO 5832-3, ASTM F136

Blind screw insert

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-proxi-

mal hole plate.

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.

Non

contact

Locking cap ∅ 8 mm

Spacer 1 to 3 mm Angular stability of one NCB Locked Screw

6 Nm

Fastening torque

225 N

SD±10N

Posterior

NCB® Proximal Tibia System– Surgical Technique 5

Standard Screws

(included in the screw set)

Cannulated Screws

(option)

Zimmer® MotionLoc® Screws

(option)

Cancellous screw ∅ 5.0 mm

self tapping, L 50–90 mm; 5 mm

L 95 & 100mm (not in set)

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

Plate Design

Two versions of the NCB PT Plate are

available: 2-proximal and 3-proximal

holes.

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 recom-

mended when there is a higher concern

for supporting the tibial plateau

(e.g. severe intra-articular comminution).

Plate head has 6˚ posterior tilt to match

the lateral tibial contour.

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

Cannulation for

1.6 mm K-wire

Cancellous screw ∅ 4.5 mm self drill

L 50–100 mm; 5 mm

3-proximal holes plate

2-proximal holes plate

30°

6°

30°

6°

6NCB® 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.

Cable Fixation with

Hex Button

Cable Fixation Options Cable Fixation with

Cable Button

NCB Locking Plate

Cable Button, 2.5mm, Hex Drive

• Sterile

• Material: Ti6Al4V

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

REF 47-2232-060-01 Color: Blue

Application

This Cable Button is threaded

directly into the NCB Plate hole to

provide a positioning point for

the Cable.

Instructions

To insert, use the 2.5mm hex

screwdriver to thread the cable

button 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.

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.

Cable Assembly Cerclage,

1.8mm

• Sterile

• Material: CoCr

REF 00-2232-002-28

REF 00-2232-004-18

* 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.

NCB® Proximal Tibia System– Surgical Technique 7

MIS Radiolucent Targeting

Device

MIS* operation technique with a

fully radiolucent targeting device.

In the metaphyseal region the targeting

device ensures divergent screw align-

ment 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).

* 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.

Divergent screw alignment achieved using

the targeting device

NCB PT Plate System

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)**

8NCB® Proximal Tibia System – Surgical Technique

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 Tibia plate from

the NCB Polyaxial Locking Plate System

is specifically designed for the proximal

tibia.

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 extremi-

ties involved.

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 condy-

lar fractures.

A1 A2 A3

B1 B2 B3

C1 C2 C3

Typ ITyp II Typ III Typ IV Typ

yp VI

OTA Classiﬁcation

Schatzker Classiﬁcation

Note: Be sure to check for proper Regula-

tory 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.

NCB® Proximal Tibia System– Surgical Technique 9

Sample Cases

Case 1: 41-C1 fracture

(OTA classification)

Postoperative

Preoperative

Postoperative

10 NCB® Proximal Tibia System – Surgical Technique

Case 2: 41-A2 fracture

(OTA classification,

MIS surgical procedure)

PostoperativePreoperative

NCB® Proximal Tibia System– Surgical Technique 11

Preoperative Planning

and Patient Positioning

Select the appropriate length and type

of the NCB PT Plate using X rays and the

X ray template (REF 06.01365.000).

Based on the fracture type and the

specific patient condition determine

the surgical approach (i.e., open

technique or MIS) to be performed.

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.

Support the knee while allowing the

leg to move freely.

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)**.

+H84406013650001/$150501E15Z

NCB®-PT Proximal Lateral Tibial Osteosynthesis Plate, with Polyaxial Locking Screws

These reference numbers must correspond

to those of the prostheses to be implanted.

Sulzerallee 8, CH-8404 Winterthur, Switzerland

Lit. No. 06.01365.000

5 cm 15 cm10 cm

Magnification

1.15:1

5 cm

10 cm

15 cm

20 cm

25 cm

0cm

0cm1cm 2cm3cm4cm5cm6cm7cm8cm9cm 10 cm

4567

NCB-Screws

self-tapping

Polyaxial Screw

100

αβγ

5 holes7 holes9 holes13 holes

δε1238910111213

Right

AP View

Lateral View

Do not bend

Left/

∅ 4

∅ 5

30°

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 antero-

lateral incision or short medial and

lateral incisions are recommended.

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.

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

Temporary stabilization of the fracture

Use of bone spacers for non-contact bridging

Incision

NCB® Proximal Tibia System– Surgical Technique 13

Screw Type

Cancellous Cortical Cancellous cannulated

REF 02.0x152.0xx REF 02.0x155.0xx REF 02.0x158.0xx

5 mm 4 mm 4.5 mm

L 50–100 mm L 14–100 mm L 50–100 mm

Drill

REF 103.25.180 REF 02.00024.118 REF 02.00024.233

2.5 mm 3.3 mm 3.3 mm

Guide Wire REF 02.01362.116

1.6 mm, L 190 mm

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.

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 exces-

sive screw angulation with consequent

failure of the locking mechanism.

Note: The ∅ 4 mm NCB MotionLoc

Screws are also compatible with all

plates in the Proximal 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 of the locking

holes

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

Drilling

Temporarily ﬁxation of the plate

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.

Insert NCB Cancellous Screws using

the NCB PT Hexagonal Screwdriver,

(REF 02.00024.124) and apply compres-

sion 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.

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.

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.

Determine screw length with the NCB Depth Gauge

Use the NCB PT Hexagonal Screwdriver to hand tighten the screw

and apply compression (if needed)

Possible setting of the most proximal cancellous screws

Insert the locking caps using the NCB Torque Screwdriver

to achieve 6 Nm

NCB® Proximal Tibia System– Surgical Technique 15

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 exces-

sive 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

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 Cannu-

lated Drill Bit (REF 02.00024.233)

only for the first lateral cortex, to make

sure that the NCB Guide Wire does

not fall out.

Use the cannulated hexagonal screw-

driver (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.

Measure the screw length with the

NCB PH/PT Measuring Device

Insert the cannulated screw with the

hexagonal cannulated screw driver

NCB® Proximal Tibia System– Surgical Technique 17

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 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 complet-

ing screw insertions.

Insert cortical screws

Possible ﬁnal screw settingInsert the locking caps using the NCB

Torque Screwdriver to achieve 6 Nm

18 NCB® Proximal Tibia System – Surgical Technique

MIS Technique

MIS is recommended for simple and/

or extra-articular fractures. An open

approach is recommended in the proxi-

mal area to restore the articular surface.

Plate Hole Numbering System

To target the correct plate holes there

is a numbering system on the targeting

devices (REF 02.00024.08x)

Screw holes in the proximal and meta-

physeal 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).

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)**.

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

4567

5 holes7 holes9 holes13 holes

δε1238910111213

NCB Plate screw hole numbering system

** 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 19

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 Connec-

tion 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.

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.

Connection bolt

Safety lock pin

Stabilization bolt

Assembly of the targeting device prior insertion

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.

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.

Close the plate targeting device conﬁguration to guarantee correct

correspondence between the targeting device and plate holes

Center the distal part of the plate Temporary ﬁxation of the plate

Posterior

NCB® Proximal Tibia System– Surgical Technique 21

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.

The screw numbered “δ” needs to

be inserted when the targeting device

is removed at the end of surgery.

The screw numbered “δ” can be

inserted using the corresponding hole

on the targeting device following the

procedure described below.

Use the drill guide and drill

bit to insert cancellous screws

as described in the open

technique

Screw hole numbering

system

4567

5 holes7 holes9 holes13 holes

δε1238910111213

22 NCB® Proximal Tibia System – Surgical Technique

Insert the tissue protection sleeve

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.

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.

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

Drill the screw hole in the bone shaft

NCB® Proximal Tibia System– Surgical Technique 23

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 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.

Remove the NCB PT Soft Tissue Protec-

tion 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.

Insert the screw in the bone shaft

Use the screw marker to indicate that the screw is inserted and

locked in the hole and proceed to insert additional screws

Insert the locking caps using the NCB Torque

Screwdriver to achieve 6 Nm

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.

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 recom-

mended a slightly longer stab incision

to visualize and avoid damage to the

Superficial Peroneal nerve.

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.

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.

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.

• In case of difficulties in loosing the

NCB Screws, tighten the screws slightly

before loosening them.

Take care to avoid damage

of the Superﬁcial Peroneal

nerve when using long plates

Remove the NCB Stabilization

Bolt and insert the NCB Protection

Sleeve to insert the most distal

cortical screw

Possible ﬁnal screw setting

NCB® Proximal Tibia System– Surgical Technique 25

Ordering Information – Implants

NCB® PT 2-proximal hole plate set

REF

ZS 02.00024.820

sterile-packed

Quantity* Holes mm Side REF

1 5 132 left 02.02261.105

1 7 172 left 02.02261.107

1 9 212 left 02.02261.109

1 5 132 right 02.02261.005

1 7 172 right 02.02261.007

1 9 212 right 02.02261.009

* 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® PT 3-proximal hole plate set

REF

ZS 02.00024.830

sterile-packed

Quantity* Holes mm Side REF

1 5 132 left 02.02261.305

1 7 172 left 02.02261.307

1 9 212 left 02.02261.309

1 5 132 right 02.02261.205

1 7 172 right 02.02261.207

1 9 212 right 02.02261.209

NCB® PT 3-proximal hole plate (optional)

3 and 13 hole lengths

sterile-packed

Quantity* Holes mm Side REF

– 3 92 left 02.02261.303 **

– 3 92 right 02.02261.203 **

– 13 292 left 02.02261.313

– 13 292 right 02.02261.213

Materials: NCB Plates and Screws are made

of Ti6Al4V, ISO 5832-3, ASTM F136

26 NCB® Proximal Tibia System – Surgical Technique

NCB® Cancellous Screw, thread length 32mm

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

2 50 5.0 3.5 02.03152.050 02.02152.050

2 55 5.0 3.5 02.03152.055 02.02152.055

3 60 5.0 3.5 02.03152.060 02.02152.060

3 65 5.0 3.5 02.03152.065 02.02152.065

3 70 5.0 3.5 02.03152.070 02.02152.070

3 75 5.0 3.5 02.03152.075 02.02152.075

3 80 5.0 3.5 02.03152.080 02.02152.080

2 85 5.0 3.5 02.03152.085 02.02152.085

2 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

NCB® Screw, self-tapping

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

2 14 4.0 3.5 02.03155.014 02.02155.014

2 16 4.0 3.5 02.03155.016 02.02155.016

2 18 4.0 3.5 02.03155.018 02.02155.018

2 20 4.0 3.5 02.03155.020 02.02155.020

2 22 4.0 3.5 02.03155.022 02.02155.022

2 24 4.0 3.5 02.03155.024 02.02155.024

2 26 4.0 3.5 02.03155.026 02.02155.026

2 28 4.0 3.5 02.03155.028 02.02155.028

2 30 4.0 3.5 02.03155.030 02.02155.030

2 32 4.0 3.5 02.03155.032 02.02155.032

4 34 4.0 3.5 02.03155.034 02.02155.034

4 36 4.0 3.5 02.03155.036 02.02155.036

4 38 4.0 3.5 02.03155.038 02.02155.038

4 40 4.0 3.5 02.03155.040 02.02155.040

4 42 4.0 3.5 02.03155.042 02.02155.042

4 44 4.0 3.5 02.03155.044 02.02155.044

2 46 4.0 3.5 02.03155.046 02.02155.046

2 48 4.0 3.5 02.03155.048 02.02155.048

2 50 4.0 3.5 02.03155.050 02.02155.050

2 55 4.0 3.5 02.03155.055 02.02155.055

2 60 4.0 3.5 02.03155.060 02.02155.060

2 65 4.0 3.5 02.03155.065 02.02155.065

2 70 4.0 3.5 02.03155.070 02.02155.070

2 75 4.0 3.5 02.03155.075 02.02155.075

2 80 4.0 3.5 02.03155.080 02.02155.080

2 85 4.0 3.5 02.03155.085 02.02155.085

2 90 4.0 3.5 02.03155.090 02.02155.090

– 95 4.0 3.5 02.03155.095 02.02155.095

– 100 4.0 3.5 02.03155.100 02.02155.100

NCB® Blind Screw Insert

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

5 8 3.5 02.03150.310 02.02150.310

NCB® Spacer

(red, blue, green)

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

2 1 3.5 red 02.03150.311 02.02150.311

2 2 3.5 blue 02.03150.312 02.02150.312

2 3 3.5 green 02.03150.313 02.02150.313

L4.2

M8 × 0.75

∅ 6.2

∅ 4

∅ 3.4

L1.75

∅ 6.2

∅ 4.2∅ 5

1.75

∅ 2.9

NCB® Locking Cap

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

15 8 3.5 02.03150.300 02.02150.300

3.9

M8 × 0.75

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

Materials: NCB Plates and Screws are made

of Ti6Al4V, ISO 5832-3, ASTM F136

NCB® Proximal Tibia System– Surgical Technique 27

NCB® MotionLoc® Screws, Ø 4.0mm Cortical,

Self Tapping, Ti6Al4V

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

∅ 4∅ 6,2

* 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.

Cable Fixation Options

REF (Sterile) Description

47-2232-060-00* NCB Polyaxial Locking Plate Cable Button, Gold, 2.5mm Hex Drive, Material: Ti6Al4V

47-2232-060-01 NCB Polyaxial Locking Plate Cable Button, Blue, 2.5mm Hex Drive, Material: Ti6Al4V

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

00-2232-004-28 Cable-Ready Cable Assembly Cerclage, ∅ 1.8mm, L 914mm, Material: CoCr

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

Materials: NCB Plates and Screws are made

of Ti6Al4V, ISO 5832-3, ASTM F136

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

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 ZS 02.00024.800

empty ZS 02.00024.810

NCB® PT Graphic Case, module

cannulated screws and implants

REF

02.00024.804

NCB® PT Graphic Case, module

screw rack

REF

02.00024.805

NCB® PT Graphic Case, lid

REF

02.00024.801

NCB® PT Graphic Case base (Inox)

REF

02.00024.802

NCB® PT Graphic Case, module

instruments

REF

02.00024.803

NCB® Proximal Tibia System– Surgical Technique 29

NCB® Drill Bit, with quick coupling

Quantity* L mm ∅ mm REF

1 195 4.3 02.00024.002

Standard Instruments

NCB® Drill Guide ∅ 2.5 mm for screws

∅ 5.0 cancellous

Quantity* ∅ mm REF

1 2.5 02.00024.010

NCB® Drill Guide 4.3 screws 5.0

Quantity* mm REF

1 4.3 02.00024.011

NCB® Torque Screwdriver, 6 Nm

Quantity* L mm ∅ mm REF

1 280 3.5 02.00024.021

NCB® Depth Gauge

Quantity* L mm ∅ mm REF

1 110 5.0/4.5/4.0 02.00024.005

NCB® PT Hexagonal Screwdriver, long

Quantity* L mm mm REF

1 275 3.5 02.00024.124

Two-fluted drill bit, with quick coupling

Quantity* L mm l mm ∅ mm REF

1 180 154 2.5 103.25.180

T-handle, with quick coupling

Quantity* REF

1 100.90.210

NCB® PT Tab 4 mm, with quick

coupling

Quantity* mm REF

1 4.0 02.00024.040

Screw forceps self-holding

Quantity* REF

1 100.90.005

NCB® Drill Guide ∅ 3.3 mm for

screws ∅ 4.0/4.5

Quantity* ∅ mm REF

1 3.3 02.00024.111

NCB® Drill Bit, with quick coupling

Quantity* L mm mm REF

1 195 3.3 02.00024.118

NCB® PT Hexagonal Screwdriver, shaft

Quantity* L mm mm REF

1 – 3.5 02.00024.027

Kirschner wire, stainless steel

Quantity* L mm mm REF

5 280 2.0 290.20.280

*Indicates the quantity in the standard graphic case.

30 NCB® Proximal Tibia System – Surgical Technique

NCB® PT Graphic Case, for

MIS instruments

REF

with content ZS 02.00024.850

empty 02.00024.806

Assembly pin

Quantity** REF

1 02.00002.001

NCB® PT Depth Gauge

Quantity** REF

1 02.00024.007

NCB® Screw Marker for targeting device

Quantity** REF

8 02.00024.077

Safety lock pin for targeting device

Quantity** REF

2 02.00024.076

MIS Instruments

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

NCB® Proximal Tibia System– Surgical Technique 31

NCB® PT Targeting Device

Quantity** Side REF

1 right 02.00024.080

1 left 02.00024.081

NCB® PT Stabilization Bolt for

targeting device

Quantity** REF

1 02.00024.084

NCB® PT K-Wire Guide ∅ 5.2/2 mm

Quantity** REF

2 02.00024.092

NCB® PT Trocar

Quantity** ∅ mm REF

2 2 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

NCB® PT Soft Tissue Protection

sleeve ∅ 10.0/8.2 mm

Quantity** REF

2 02.00024.090

NCB® PT Connection Bolt

Quantity** REF

1 02.00024.083

NCB® PT Drill Guide 8.2/5.2 mm

Quantity** REF

2 02.00024.091

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

32 NCB® Proximal Tibia System – Surgical Technique

Cannulated Options (Screws and Instruments)

NCB® PH Guide Wire with threaded tip

Quantity*** L mm mm REF

5 190 1.6 02.01362.116

NCB® PH/PT Measuring Device for

cannulated screws

Quantity*** REF

1 02.00024.219

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

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

NCB® Cannulated Cancellous Screw

∅ 4.5 mm, self-drill 24 mm thread length

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

2 50 4.5 3.5 02.03158.050 02.02158.050

2 55 4.5 3.5 02.03158.055 02.02158.055

3 60 4.5 3.5 02.03158.060 02.02158.060

3 65 4.5 3.5 02.03158.065 02.02158.065

3 70 4.5 3.5 02.03158.070 02.02158.070

3 75 4.5 3.5 02.03158.075 02.02158.075

3 80 4.5 3.5 02.03158.080 02.02158.080

2 85 4.5 3.5 02.03158.085 02.02158.085

2 90 4.5 3.5 02.03158.090 02.02158.090

– 95 4.5 3.5 02.03158.095 –

– 100 4.5 3.5 02.03158.100 –

∅ 3.5

∅ 1.75

∅ 3.2 ∅ 4.5 ∅ 6.2

1.75

NCB® PT Drill Guide 3.3/1.6 mm

Quantity*** REF

2 02.00024.192

Cannulated Screws and Instrument Set

REF

ZS 02.00024.840

Materials: NCB Plates and Screws are made

of Ti6Al4V, ISO 5832-3, ASTM F136

NCB® Proximal Tibia System– Surgical Technique 33

Planning Aid

X ray template REF 06.01365.000

+H84406013650001/$150501E15Z

NCB®-PT Proximal Lateral Tibial Osteosynthesis Plate, with Polyaxial Locking Screws

These reference numbers must correspond

to those of the prostheses to be implanted.

Sulzerallee 8, CH-8404 Winterthur, Switzerland

Lit. No. 06.01365.000

5 cm 15 cm10 cm

Magnification

1.15:1

5 cm

10 cm

15 cm

20 cm

25 cm

0cm

0cm1cm 2cm3cm4cm5cm6cm7cm8cm9cm 10 cm

4567

NCB-Screws

self-tapping

Polyaxial Screw

100

αβγ

5 holes7 holes9 holes13 holes

δε1238910111213

Right

AP View

Lateral View

Do not bend

Left/

∅ 4

∅ 5

30°

34 NCB® Proximal Tibia System – Surgical Technique

Notes

NCB® Proximal Tibia System– Surgical Technique 35

Lit.No. 06.01369.022 – Ed.2015-08

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.

NCB® Proximal Tibia System Surgical Technique Ncb

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