MAUDE Adverse Event Report: ZIMMER SWITZERLAND MANUFACTURING GMBH ANN, PROXIMAL HUMERUS, RIGHT, 9X160MM; ROD, FIXATION, INTRAMEDULLARY

Model Number	47-2496-160-09
Medical Device Problem Codes	Migration or Expulsion of Device (1395); Expulsion (2933)
Health Effect - Clinical Codes	Failure of Implant (1924); Necrosis (1971)
Date of Event	04/13/2022
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Zimmer biomet reference: (b)(4).The manufacturer received x-rays and will be reviewed as part of ongoing investigation.The manufacturer did not receive the device for investigation yet.Lot number were not received for the device, the device history records could therefore not be reviewed.A cause for this specific event cannot be ascertained from the information provided.As soon as supplemental information becomes available an updated report will be submitted.Multiple mdr reports were filed for this event, please see associated reports: 0009613350-2022-00273.
Event or Problem Description
It was reported that 6 weeks after implantation, patient experienced humeral head necrosis.Proximal screw next to the screw hole had migrated.Revision surgery has been planned.Attempts have been made and no further information has been provided yet.
Additional Manufacturer Narrative
This follow-up report is being submitted to relay additional and corrected information.The following sections were updated: a1, a2, a3, b4, b5, d1, d2, d4, d9, d10, e1, g3, g4, g6, h1, h2, h3, h4, h6, h10 d10 - medical devices: ann blunt tip screw 4x48mm; item# 47248604840; lot# 3068481 ann blunt tip screw 4x40mm; item# 47248604040; lot# 3076831 ann blunt tip screw 4x42mm; item# 47248604240; lot# 3076739 ann blunt tip screw 4x48mm; item# 47248604840; lot# 3073797 ann cort bone screw 4x24mm; item# 47248612440; lot# 3081954 ann cort bone screw 4x26mm; item# 47248612640; lot# unknown multiple mdr reports were filed for this event, please see associated reports: 0009613350-2022-00439 0009613350-2022-00440 0009613350-2022-00441 the products were returned for examination.Signs of wear on the threads of the blunt tip screws are minimal to non-existant, which is uncommon for migration cases.Additionally, the received nail has minimal scratches up until the proximal bore holes, where the 3rd most proximal hole has several scratches at the chamfer, likely originating from vibration or migration of the screw.The corelock mechanism is still contained within the nail.The cortical screws are inconspicuous.Review of the device history records identified no deviations or anomalies during manufacturing.Devices are used for treatment.Medical records in the form of x-rays were provided.The post-operative x-rays are ap views, with the humerus in one of the images being internally rotated.A serious fracture of the humerus is clearly visible.The lateral pre-operative image is not of much merit to the investigation, however shows an anterior dislocation of the humeral head.The second pre-operative image shows clear signs of humeral head necrosis.A possible screw migration can not be assessed due to the rotation of the humerus in comparison with the post-operative x-ray.Based on the investigation it could be assumed that further possible contributing factors to the migration of the screw might be multifactorial related to either patient condition, behavior or implantation procedure.Of note is the evident humeral head necrosis as seen on the x-rays, which likely caused or contributed to the reported event of screw migration.The cause of humerhal head necrosis however is unknown, but might be related to the severity of the humeral head fracture sustained prior to implantation of the devices.If and to what extent any of these aspects may have influenced the migration of the screw remains unknown.The design limitation of the corelock mechanism was also investigated as a potential contributing factor.However, biomechanical testing determined that the product performance is in an acceptable range in comparison with legally marketed similar devices.In conclusion, as the cause may be multifactorial an exact root cause could not be identified for the migration of the screw.If any further information is found which would change or alter any conclusions or information, a supplemental report will be filed accordingly.Zimmer biomet will continue to monitor for trends.
Event or Problem Description
No further event information available at the time of this report.

• Brand Name: ANN, PROXIMAL HUMERUS, RIGHT, 9X160MM
• Common Device Name: ROD, FIXATION, INTRAMEDULLARY
• Manufacturer (Section D): ZIMMER SWITZERLAND MANUFACTURING GMBH; sulzer allee 8; sulzer industrie park; winterthur 8404 ; SZ 8404
• Manufacturer (Section G): ZIMMER SWITZERLAND MANUFACTURING GMBH; sulzer allee 8; sulzer industrie park; winterthur 8404 ; SZ 8404
• Manufacturer Contact: christina arnt ; 56 e. bell dr.; warsaw, IN 46582 ; 5745273773
• MDR Report Key: 14352013
• Report Number: 0009613350-2022-00272
• Device Sequence Number: 17348189
• Product Code: HSB
• UDI-Device Identifier: 00889024505780
• UDI-Public: (01)00889024505780(17)310527(10)3067307
• Combination Product (Y/N): N
• Initial Reporter Country: GM
• PMA/510(K) Number: K200814
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2022
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Foreign,Health Professional,Company Representative
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 08/29/2022

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: 47-2496-160-09
• Device Catalogue Number: 47-2496-160-09
• Device Lot Number: 3067307
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 04/13/2022
• Supplement Date Received by Manufacturer: 08/15/2022
• Initial Report FDA Received Date: 05/11/2022
• Supplement Report FDA Received Date: 09/05/2022
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 05/26/2021
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• If action reported to FDA under 21 USC 360i(g), list FDA-assigned Recall Number or include a statement: N/A
• Patient Sequence Number: 1
• Concomitant Medical Products and Therapy/Usage Dates: SEE H10 NARRATIVE
• Outcome Attributed to Adverse Event: Other; Hospitalization; Required Intervention
• Patient Sex: Female