MAUDE Adverse Event Report: SMITH & NEPHEW, INC. G2 DISH ART TR SZ7-8 9MM; ORTHOPEDIC MANUAL SURGICAL INSTRUMENT

Model Number	71430789
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	12/21/2020
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
(b)(4).
Event or Problem Description
It was reported that, during a tka procedure, a a small piece of the genesis ii dish art tr size 7-8 9mm broke off of it.The piece was not left in the patient, but was discarded.No further complications were reported.All available information has been disclosed.If additional information should become available, a supplemental report will be submitted accordingly.
Additional Manufacturer Narrative
Results of investigation: the device, used in treatment, was returned for evaluation.The clinical/medical team concluded, per complaint details, while the surgeon was removing the trial liner during the tka, a small piece broke off of it; however, the procedure was finished with the same device without delay.Reportedly all parts were recovered/no retained pieces in the patient and no patient injury or other complications were reported.The product evaluation was performed and reported independent of the medical investigation.Patient impact beyond the reported unanticipated medical intervention (removal of trial liner fragment piece) would not be anticipated as the procedure was reportedly completed with the same devices without retained foreign bodies, patient harm, and/or surgical delay.Since no patient injury/harm was alleged, no further medical assessment is warranted at this time.A visual inspection confirmed the g2 dish art tr sz7-8 9mm shows nicks and scratches.The device shows significant signs of wear/usage.A review of the manufacturing records did not reveal a manufacturing abnormality that could have caused or contributed to the reported incident.At this time, we have no reason to suspect that the products failed to meet any product specifications at the time of manufacture.A review of complaint history for the listed part revealed no prior complaints for the listed batch.A review of the risk management file revealed this failure mode was previously identified.Damage from prolonged use, misuse or rough handling are likely probable causes of the reported event.We recommend that all reusable instruments be routinely inspected for wear and damage and replaced as necessary.This is a reusable instrument that can be exposed to numerous surgeries; damage from repeated use can occur.Based on this investigation, the need for corrective action is not indicated.Should additional information be received, the complaint will be reopened.No further investigation warranted for this complaint; however we will continue to monitor for future complaints and investigate as necessary.We consider this investigation closed.

• Brand Name: G2 DISH ART TR SZ7-8 9MM
• Common Device Name: ORTHOPEDIC MANUAL SURGICAL INSTRUMENT
• Manufacturer (Section D): SMITH & NEPHEW, INC.; 1450 brooks rd.; memphis TN 38116
• MDR Report Key: 11114870
• Report Number: 1020279-2021-00080
• Device Sequence Number: 3595596
• Product Code: LXH
• UDI-Device Identifier: 03596010213242
• UDI-Public: 03596010213242
• Combination Product (Y/N): N
• Initial Reporter State: FL
• Initial Reporter Country: US
• PMA/510(K) Number: EXEMPT
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Serviced by Third Party (Y/N): N
• Reporter Type: Manufacturer
• Report Source: company representative,health
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 03/18/2021

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Operator of Device: Health Professional
• Device Model Number: 71430789
• Device Catalogue Number: 71430789
• Device Lot Number: 12EM06215
• Was Device Available for Evaluation?: No
• Initial Date Received by Manufacturer: 12/21/2020
• Supplement Date Received by Manufacturer: 02/18/2021
• Initial Report FDA Received Date: 01/04/2021
• Supplement Report FDA Received Date: 03/18/2021
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention