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(b)(4).D4: product id was provided for four screws however, it is unknown which of the four screws has migrated.Therefore, the migrated screw could be any of the following: 47248604040 - blunt tip screw, ã¿ 4x40mm- 3208158, udi: (b)(4), manufacturing date: jul 2, 2024, expiration date: jul 2, 2029.47248604240 - blunt tip screw, ã¿ 4x42mm - 3210085, udi: (b)(4), manufacturing date: jul 18, 2024, expiration date: jul 18, 2029.47248604440 - blunt tip screw, ã¿ 4x44mm - 3215743, udi: (b)(4), manufacturing date: sep 11, 2024, expiration date: sep 11, 2029.47248604840 - ann blunt tip screw 4x48mm - 3203206, udi: (b)(4), manufacturing date: may 17, 2024, expiration date: may 17, 2029.D10: item # 47249624009, proximal humerus, right, long, ã¿ 10x240mm, lot # 3175007.Item # 47248604240, blunt tip screw, ã¿ 4x42mm, lot # 3210085.Item # 47248604440, blunt tip screw, ã¿ 4x44mm, lot # 3215743.Item # 47248604840, ann blunt tip screw 4x48mm, lot # 3203206.Item # 47248612640, ann cort bone screw 4 x 26mm, lot # 3204759.Item # 47248612640, ann cort bone screw 4 x 26mm, lot # 3215081.Item # 47248801000, affixus ph nl cap 0mm, lot # 3218785.G2: report source japan.The device will not be returned for analysis; however, an investigation of the reported event is in progress.Once the investigation is completed, a supplemental medwatch 3500a will be submitted.
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(b)(4).This follow-up report is being submitted to relay additional information.The following sections were updated: no product was returned or pictures provided; a product evaluation could not be performed.A review of the device manufacturing records confirmed no abnormalities or deviations.Review of the complaint histories identified additional similar complaints for the reported items and no additional similar complaints for the reported part and lot combinations.Medical records were not provided.The surgical technique explains that the locking of the corelock is done using the corelock driver with torque limiting handle."turn slowly clockwise to tighten and engage the corelock mechanism until a click is felt from the torque limiting handle." it can be assumed that multiple contributing factors, related to either patient condition and behavior or implantation procedure, contributed to the migration of the screws.If and to what extent any of these aspects may have influenced the migration of the screw remains unknown.An additional deeper investigation was performed which identified the design limitation of the corelock mechanism of the affixus nail as a potential contributing factor.As part of the deeper investigation, a scientific literature search was conducted and a systematic review of the outcome of intramedullary nailing for acute proximal humerus fracture showed that screw migration and perforation into the joint is the second most common complication following secondary loss of reduction.In addition, scientific literature of competitor and predicate devices were assessed.This review has shown that the affixus® natural nail® proximal humeral system performs better and/or in equal range in comparison with legally marketed similar devices.In conclusion, as the cause may be multifactorial an exact root cause could not be identified for the migration of the screw.If any further information is found which would change or alter any conclusions or information, a supplemental will be filed accordingly.Zimmer biomet will continue to monitor for trends.
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