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The reported event could be confirmed, since the device was received for inspection and was broken as reported.The visual inspection revealed the following: the received nail is completely broken in the webs of the proximal lag screw hole.Heavy material deformation can be seen on the web of distal end which most likely had created the starting point of the fracture at lateral.The lag screw bearing point shows strong impression marks and deformation which may come from the high compressive load, indicating the nail was exposed to continuous high load over a long period of time.On the proximal side, instantaneous breakage can be seen at medial.There is a fatigue zone with a smooth surface and progression lines over almost the whole surface of the fracture.Therefore, the breakage pattern resembles a fatigue breakage of the nail.Furthermore, the provided details and x-rays were forwarded to medical affairs, with the following result: "a subtrochanteric / reverse trochanteric fracture with a lack of stability after fixation.This causes the movement in the nail-lag screw interface and leads to breakage.Based on the provided information, the root cause of the reported event is muti-factorial: the location of the fracture and the technical aspects of the surgical procedure may have contributed to the event.Furthermore, patient activity levels post-op, co-morbidities may also have contributed to an inadequate load distribution, and therefore the breakage of the implant." 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.If more information is provided, the case will be reassessed.
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