MAUDE Adverse Event Report: SMITH & NEPHEW, INC. HUMERAL RULER; ROD, FIXATION, INTRAMEDULLARY AND ACCESSORIES

Model Number	71751126
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Code	No Consequences Or Impact To Patient (2199)
Date of Event	08/06/2020
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that during surgery, the humeral ruler broke external to patient.No broken pieces fell inside the patient's wound.The procedure was finished using a smith and nephew back up device, with no surgical delay and no injury to the patient.
Additional Manufacturer Narrative
The device, used in treatment, was returned for evaluation.A visual inspection of the returned humeral ruler confirms the inner piece of the device is missing and was not returned for evaluation.The piece that was returns confirms signs of scratches, burrs and gouges in the metal.The product marking is fading on the device as well.This device exhibits signs of significant wear/usage.This device was manufactured in 2011.A review of complaint history on the listed part revealed no prior complaint for the listed batch with the same failure mode.A review of the manufacturing records did not reveal any manufacturing or material abnormalities that could have caused or contributed to the reported incident.This device is a reusable instrument that can be exposed to numerous surgeries; damage from repeated use can occur.Expected wear/tear is likely the probable cause of the reported event.We recommend that all reusable instruments be routinely inspected for wear and damage and replaced as necessary.At this time, we have no reason to suspect that the product failed to meet any product specifications at the time of manufacture.Based on this investigation, the need for corrective action is not indicated.Should additional information be received, the complaints will be reopened.No further investigation is warranted for these complaints; however we will continue to monitor for future complaints and investigate as necessary.We consider this investigation closed.

• Brand Name: HUMERAL RULER
• Common Device Name: ROD, FIXATION, INTRAMEDULLARY AND ACCESSORIES
• Manufacturer (Section D): SMITH & NEPHEW, INC.; 1450 brooks rd.; memphis TN 38116
• MDR Report Key: 10497547
• Report Number: 1020279-2020-04412
• Device Sequence Number: 2889872
• Product Code: HSB
• UDI-Device Identifier: 03596010514714
• UDI-Public: 03596010514714
• Combination Product (Y/N): N
• Initial Reporter State: SC
• Initial Reporter Country: US
• PMA/510(K) Number: K122170
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,health
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 09/18/2020

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: No
• Is this a Product Problem Report?: Yes
• Operator of Device: Health Professional
• Device Model Number: 71751126
• Device Catalogue Number: 71751126
• Device Lot Number: 11HST0021B
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 08/31/2020
• Initial Date Received by Manufacturer: 08/06/2020
• Supplement Date Received by Manufacturer: 09/10/2020
• Initial Report FDA Received Date: 09/04/2020
• Supplement Report FDA Received Date: 09/18/2020
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1