MAUDE Adverse Event Report: TREACE MEDICAL CONCEPTS, INC. TMC 3.0MM COMPRESSION SCREW SYSTEM - INTERFRAG

Model Number	SK18
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Code	Device Embedded In Tissue or Plaque (3165)
Date of Event	06/28/2023
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
It was reported that after an initial bunion surgery on (b)(6) 2022, all hardware was removed in a revision surgery on (b)(6) 2023 due to nonunion, a broken plate and broken screw.The tip of the broken screw was retained in the patient's bone.The site was revised with non-tmc hardware and no other patient outcomes were reported as a result of this event.No devices were returned for evaluation.The device history records were reviewed, and no issues were identified during the manufacture and release of the devices that could have contributed to what was reported.Although a number of factors could have contributed to what was reported, the most likely cause cannot be determined due to the device not being returned for evaluation.However, it is possible the devices were subjected to excessive bending stresses leading to their breakage.The company will supplement this mdr as necessary and appropriate.The broken plate was reported in mdr 3011623994-2023-00186.
Event or Problem Description
It was reported that after an initial bunion surgery on (b)(6) 2022, all hardware was removed in a revision surgery on (b)(6) 2023 due to nonunion, a broken plate and broken screw.The tip of the broken screw was retained in the patient's bone.The site was revised with non-tmc hardware and no other patient outcomes were reported as a result of this event.

• Brand Name: TMC 3.0MM COMPRESSION SCREW SYSTEM - INTERFRAG
• Common Device Name: SCREW
• Manufacturer (Section D): TREACE MEDICAL CONCEPTS, INC.; 100 palmetto park place; ponte vedra FL 32081
• Manufacturer (Section G): TREACE MEDICAL CONCEPTS, INC.; 100 palmetto park place; ponte vedra FL 32081
• Manufacturer Contact: uriza shums ; 100 palmetto park place; ponte vedra, FL 32081 ; 9043735940
• MDR Report Key: 17407164
• Report Number: 3011623994-2023-00187
• Device Sequence Number: 6093438
• Product Code: HWC
• UDI-Device Identifier: 00853114006068
• UDI-Public: 00853114006068
• Combination Product (Y/N): N
• Initial Reporter State: FL
• Initial Reporter Country: US
• PMA/510(K) Number: K213036
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2022
• Device Explanted Year: 2023
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Company Representative
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial
• Report Date (Section B): 07/27/2023

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 Expiration Date: 03/24/2025
• Device Model Number: SK18
• Device Lot Number: 300101425
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 06/28/2023
• Initial Report FDA Received Date: 07/27/2023
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 03/24/2022
• 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
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Age: 68 YR
• Patient Sex: Female