MAUDE Adverse Event Report: TORNIER S.A.S. TORNIER FLEX SHOULDER SYS REV INSERT 42MM 9TH C 7.5DG; TORNIER FLEX SHOULDER SYS REV TRAY 0TH 3.5MM OFFSET

Catalog Number	DWF425C
Medical Device Problem Code	Device Dislodged or Dislocated (2923)
Health Effect - Clinical Code	Joint Dislocation (2374)
Date of Event	08/28/2023
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Device will not be returned.If additional information becomes available, it will be provided on a supplemental report.H3 other text : device disposition unknown.
Event or Problem Description
The patient dislocated their shoulder and underwent surgery after a waiting period.During the surgery, a piece of bone causing the dislocation was sanded down.The patient wore a sling throughout the recovery period but did not receive any physical therapy.
Additional Manufacturer Narrative
The reported event was not confirmed since no other evidence was provided regarding the first shoulder dislocation (no images provided).A device inspection was not possible since the affected device was not returned for evaluation.An x-rays inspection done by the medical expert from the provided x-rays (taken after the surgery of the second dislocation) revealed the following: images ¿show absence of the greater tuberosity and (¿) the absence of the lesser tuberosity in the correct place¿ (¿it is not likely the either greater or lesser tuberosity were anatomically reduced two months earlier), ¿the tray pointing left from the axis of the stem which is suggestive for retroversion¿, on the provided x-rays ¿only the third dislocation was apparent¿.Since data were provided, the opinion of a medical expert was sought and stated as following: "(.) after the revision surgery for the periprosthetic fracture, the right shoulder x-rays showed absence of the proximal humeral tuberosities, hence lack of attachment of an adequate soft tissue envelope to provide optimal support to joint stability (patient-related).In addition to that there may have been some excessive retroversion of the revive stem¿s proximal body (surgeon-related).(.) all-in-all a revision case because of a periprosthetic fracture, that have led to a situation of grossly disturbed anatomy due to patient-related factors and in addition to that possibly some excessive retroversion of the revision stem-construct (surgeon reported, although not quantified).In the images provided the implants are intact".A review of the device history for the reported lot did not indicate any abnormalities.No corrective actions are required at this time.A review of the labeling did not indicate any abnormalities.No indications of material, manufacturing or design related problems were found during the investigation.Based on investigation, the root cause was attributed mainly to a patient-related issue.The instability followed the revision surgery for a postoperative traumatic periprosthetic humeral fracture which highly disturbed the patient¿s right shoulder anatomy (lack of soft tissues around the proximal part of the humerus and rotator cuff soft tissue reconstruction time).If the devices are returned or if any additional information is provided, the investigation will be reassessed.
Event or Problem Description
The patient dislocated their shoulder and underwent surgery after a waiting period.During the surgery, a piece of bone causing the dislocation was sanded down.The patient wore a sling throughout the recovery period but did not receive any physical therapy.

• Brand Name: TORNIER FLEX SHOULDER SYS REV INSERT 42MM 9TH C 7.5DG
• Common Device Name: TORNIER FLEX SHOULDER SYS REV TRAY 0TH 3.5MM OFFSET
• Manufacturer (Section D): TORNIER S.A.S.; 161 rue lavoisier; montbonnot saint-martin 38330 ; FR 38330
• Manufacturer (Section G): TORNIER S.A.S.; 161 rue lavoisier; montbonnot saint-martin 38330 ; FR 38330
• Manufacturer Contact: anna jusinski ; 325 corporate drive; mahwah, NJ 07430 ; 2018315000
• MDR Report Key: 19005650
• Report Number: 3000931034-2024-00171
• Device Sequence Number: 8434672
• Product Code: KWS
• UDI-Device Identifier: 03700434022445
• UDI-Public: 03700434022445
• Combination Product (Y/N): N
• Initial Reporter State: FL
• Initial Reporter Country: US
• PMA/510(K) Number: K122698
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Consumer
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 06/24/2024

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?: No
• Operator of Device: Lay User/Patient
• Device Catalogue Number: DWF425C
• Device Lot Number: 5891AY
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Type of Report(Section G): Follow-Up
• Initial Date Received by Manufacturer: 03/04/2024
• Supplement Date Received by Manufacturer: 05/29/2024
• Initial Report FDA Received Date: 03/29/2024
• Supplement Report FDA Received Date: 06/24/2024
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 12/14/2022
• 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: 65 YR
• Patient Sex: Female
• Patient Weight: 84 KG