MAUDE Adverse Event Report: ARTHREX, INC. VOLAR DISTAL RAD PLT TI NARROW RT 3H; BONE FIXATION PLATE

Model Number	VOLAR DISTAL RAD PLT TI NARROW RT 3H
Medical Device Problem Code	Device Dislodged or Dislocated (2923)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	12/08/2021
Type of Reportable Event	Malfunction
Additional Manufacturer Narrative
This 3500a record is submitted to comply with an fda 483 inspectional observation issued to arthrex inc on may 5, 2023.Arthrex has reassessed the reportability decisions made on historical complaint records using revised criterion.This 3500a document is a result of the reassessment.The contribution of the device to the reported event could not be determined as the device was not returned for evaluation.The most likely cause of the reportable failure could be questionable user handling/surgical technique.
Event or Problem Description
On 12/09/2021, it was reported by a facility representative via e-mail that there was an issue with locking screws engaging with the ar-8916vnr-03 volar plate.This occurred during a distal radius surgery on 12/08/2021 when the surgeon tried using the variable angle guide to insert (3) ar-8724v-22, (2) ar-8724v-2, and (1) ar-8724v-16 screws into the ar-8916vnr-03 volar plate.Additional information requested.Additional information provided on 12/10/2021 : the device was used in the procedure, but when it was realized the screws were not locking into the plate, a backup plate and screws that worked properly were used to complete the case.

• Brand Name: VOLAR DISTAL RAD PLT TI NARROW RT 3H
• Common Device Name: BONE FIXATION PLATE
• Manufacturer (Section D): ARTHREX, INC.; 1370 creekside boulevard; naples FL 34108 1945
• Manufacturer (Section G): ARTHREX, INC.; 1370 creekside boulevard; naples FL 34108 1945
• Manufacturer Contact: jared engle ; 8009337001
• MDR Report Key: 19483227
• Report Number: 1220246-2024-05174
• Device Sequence Number: 20840548
• Product Code: HRS
• UDI-Device Identifier: 00888867130920
• UDI-Public: 00888867130920
• Combination Product (Y/N): N
• Initial Reporter State: LA
• Initial Reporter Country: US
• PMA/510(K) Number: K150456
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: User Facility
• Initial Reporter Occupation: Administrator/Supervisor
• Type of Report: Initial
• Report Date (Section B): 06/07/2024

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: VOLAR DISTAL RAD PLT TI NARROW RT 3H
• Device Catalogue Number: AR-8916VNR-03
• Device Lot Number: 11680320
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 12/09/2021
• Initial Report FDA Received Date: 06/07/2024
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 01/06/2021
• 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
• Patient Sequence Number: 1
• Patient Sex: Unknown