MAUDE Adverse Event Report: ARTHREX, INC. SUTR ANCH,CRKSCRW FT; BONE FIXATION SCREW/PLATE

Model Number	SUTR ANCH,CRKSCRW FT
Medical Device Problem Code	Break (1069)
Health Effect - Clinical Code	No Clinical Signs, Symptoms or Conditions (4582)
Date of Event	10/18/2024
Type of Reportable Event	Malfunction
Event or Problem Description
It was reported that during a rotoator cuff repair surgery the anchor broke during implantation.Per complaint reporter there was no harm for patient, operator or third party.The surgery was finished successfully with a new device with the same part number.It was not necessary to switch the surgical technique or do a second surgery.Update kpilz 29-oct-2024: all parts were retrieved from the patient.
Additional Manufacturer Narrative
Investigation is in process.A follow-up report will be provided upon availability of additional information.
Additional Manufacturer Narrative
Additional information: d9, g3, h3, h6 complaint allegation is confirmed.One unpackaged ar-1928sf-45-1 corkscrew was received for investigation.Visual evaluation of the returned device noted that the tip of the device was broken and it appeared a fragment was missing.No fragments were returned for investigation.Further visual evaluation of the device noted that the thread was slightly damaged.Functional testing was not performed due to the damage to the device.The most likely cause for the reported failure can be attributed to use error due to improper bone preparation; misaligned insertion; or prying/leveraging the device during use.

• Brand Name: SUTR ANCH,CRKSCRW FT
• Common Device Name: BONE FIXATION SCREW/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: 20587253
• Report Number: 1220246-2024-08368
• Device Sequence Number: 8804183
• Product Code: HWC
• UDI-Device Identifier: 00888867284951
• UDI-Public: (01)00888867284951(11)230926(17)280831(10)15146329
• Combination Product (Y/N): N
• Initial Reporter Country: IT
• PMA/510(K) Number: K061863
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Reporter Type: Manufacturer
• Report Source: Foreign,Company Representative
• Initial Reporter Occupation: Administrator/Supervisor
• Type of Report: Initial,Followup
• Report Date (Section B): 01/29/2025

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: SUTR ANCH,CRKSCRW FT
• Device Catalogue Number: AR-1928SF-45-1
• Device Lot Number: 15146329
• Was Device Available for Evaluation?: Yes
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 10/18/2024
• Supplement Date Received by Manufacturer: 01/03/2025
• Initial Report FDA Received Date: 11/01/2024
• Supplement Report FDA Received Date: 01/29/2025
• Was Device Evaluated by Manufacturer? (Y/N): Device Not Returned to Manufacturer
• Date Device Manufactured: 09/26/2023
• 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