| Catalog Number |
23510110 |
| Medical Device Problem Codes |
Break (1069); Fracture (1260); Material Deformation (2976)
|
| Health Effect - Clinical Code |
Foreign Body In Patient (2687)
|
| Date of Event |
02/06/2025
|
|
Type of Reportable Event
|
Serious Injury
|
|
Event or Problem Description
|
|
As reported: "during the t2 alpha tibia removal surgery, the end cap could not be removed, and the surgery was finished with the t2 nail remaining to the patient.Also two screwdriver tips were damaged by the torque.".
|
| |
|
Additional Manufacturer Narrative
|
|
Once the investigation is completed any additional information will be reported in a supplemental report.
|
| |
|
Additional Manufacturer Narrative
|
|
The reported event could be confirmed, since the device was returned for evaluation and matches the alleged failure.The screwdriver bit was received with a broken tip and the broken tip was not returned.The broken surface of the screwdriver bit shows signs of ductile fracture due to torsional overload.The breakage surface shows a little cup type formation and the edges of the hexagonal tip also showing deformation in anticlockwise direction due to excess torsional force.Furthermore, a hardness test according to rockwell on the returned item indicates the material being in accordance with the values in the material specification.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 the investigation, the root cause was attributed to be user related.The event was caused due to application of excess torsional forces while removing the end cap.If any additional information is provided, the investigation will be reassessed.
|
| |
|
Event or Problem Description
|
|
As reported: "during the t2 alpha tibia removal surgery, the end cap could not be removed, and the surgery was finished with the t2 nail remaining to the patient.Also two screwdriver tips were damaged by the torque.".
|
| |
|
Search Alerts/Recalls
|