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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: SMITH & NEPHEW, INC. EVOS SMALL 2.5MM DRILL W/AO QC LONG; INSTRUMENT, SURGICAL, ORTHOPEDIC, AC-POWERED MOTOR AND ACCESSORY/ATTACHMENT

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SMITH & NEPHEW, INC. EVOS SMALL 2.5MM DRILL W/AO QC LONG; INSTRUMENT, SURGICAL, ORTHOPEDIC, AC-POWERED MOTOR AND ACCESSORY/ATTACHMENT Back to Search Results
Catalog Number 71175022
Medical Device Problem Code Fracture (1260)
Health Effect - Clinical Codes Foreign Body In Patient (2687); Device Embedded In Tissue or Plaque (3165)
Date of Event 06/17/2025
Type of Reportable Event Serious Injury
Event or Problem Description
It was reported that, during an internal fixation surgery, one (1) evos small 2.5mm drill w/ao qc long broke off in patient bone.One piece of the drill bit stayed behind in the patient bone.The procedure was resumed, without any delay, using a s+n back-up device.No further complications were reported.
 
Additional Manufacturer Narrative
H10: internal complaint reference: (b)(4).H3, h6: this complaint was opened by smith+nephew to document a patient complication related to a product problem with a smith+nephew device.The reported issue(s) relate to known inherent device and/or procedural risks that are appropriately documented in our risk files.Smith+nephew will continue to monitor trends in accordance with our post-market surveillance process and take necessary action as required if anticipated severity and/or occurrence rates are exceeded.Smith+nephew has no reason to suspect that the product failed to meet any specifications at the time of manufacture.Based on our review of all currently available information, we are unable to identify a definitive root cause.However, as the use of our product cannot be excluded as a potential cause or contributory factor to the reported issue, we are submitting this report in accordance with applicable regulations.If additional investigative findings or information becomes available that alters the conclusions of this report, a follow-up report will be submitted as required.
 
Additional Manufacturer Narrative
H6: health effect - clinical code.The device was not returned for evaluation.However, the photographs were reviewed, and revealed that the device is fractured along the tip.The clinical/medical investigation concluded that, the provided photocopied image does support the complaint as it appears a fragment of the drill is retained in the bone and is close to, if not possibly intersecting the plate; however, it does not provide further insight into a clinical root cause of the event.There is no indication that a revision/removal procedure is planned.The material composition of the retained drill bit tip is stainless steel.The device is an externally communicating device not manufactured nor intended for implantation; therefore, it is not approved for long-term internal tissue exposure and long-term implantation data is not readily available.A user technique/variance cannot be ruled out with certainty.Patient impact beyond the retained non-implantable fragment cannot be determined.Since the drill tip is reportedly ¿in the patient bone¿, device migration and/or micro-motion (although unlikley) cannot be predicted.The potential risk for corrosion, localized discomfort/inflammation/pain and micro-motion cannot be ruled out.A review of the production order did not reveal a manufacturing abnormality that could have caused or contributed to the reported incident.A review of complaint history revealed a similar event for the listed part number over the previous 12 months, but no similar events for the batch based on the historical data, this failure mode will be monitored for future complaints for any necessary corrective actions.A review of instructions for care, maintenance, cleaning and sterilization of smith & nephew orthopedics devices for single use devices revealed that as the devices are sold both nonsterile and sterile and often removed from their original packaging to be placed in a containment device they should be cleaned and/or inspected prior to sterilization.The device should not be reprocessed or reused if comes in contact with blood, tissue or bodily fluids.A review of the risk management file revealed this failure mode was previously identified.The anticipated risk level is still adequate.A historical review concluded that there are no prior actions related to this product and event.At this time, we have no evidence to conclude that the product failed to meet any specifications at the time of manufacture.This is a single use device, surgical technique or damage from misuse are likely potential factors that could contribute to the reported event.Based on this investigation, the need for corrective action is not indicated.Should the device or additional information be received, the complaint will be reopened.No further investigation is warranted for this complaint; however, we will continue to monitor for future complaints and investigate as necessary.We consider this investigation closed.
 
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Brand Name
EVOS SMALL 2.5MM DRILL W/AO QC LONG
Common Device Name
INSTRUMENT, SURGICAL, ORTHOPEDIC, AC-POWERED MOTOR AND ACCESSORY/ATTACHMENT
Manufacturer (Section D)
SMITH & NEPHEW, INC.
1450 brooks rd.
memphis TN 38116
Manufacturer (Section G)
SMITH & NEPHEW, INC.
1450 brooks rd.
memphis TN 38116
Manufacturer Contact
holly topping
1450 brooks rd.
memphis, TN 38116
5123913905
MDR Report Key22464907
Report Number1020279-2025-01196
Device Sequence Number14511787
Product Code HWE
UDI-Device Identifier00885556635766
UDI-Public885556635766
Combination Product (Y/N)N
Initial Reporter CountrySF
Number of Events Summarized1
Summary Report (Y/N)N
Serviced by Third Party (Y/N)N
Reporter Type Manufacturer
Report Source Other,Foreign,Health Professional,Company Representative
Initial Reporter Occupation Physician
Type of Report Initial,Followup
Report Date (Section B) 08/19/2025
1 Device was Involved in the Event
1 Patient was Involved in the Event
Is this an Adverse Event Report? Yes
Is this a Product Problem Report? Yes
Operator of Device Health Professional
Device Catalogue Number71175022
Device Lot Number23AUQ0019
Was Device Available for Evaluation? No
Is the Reporter a Health Professional? Yes
Type of Report(Section G)Thirty-Day
Initial Date Received by Manufacturer 06/17/2025
Supplement Date Received by Manufacturer08/13/2025
Initial Report FDA Received Date07/09/2025
Supplement Report FDA Received Date08/19/2025
Was Device Evaluated by Manufacturer? (Y/N) Device Not Returned to Manufacturer
Date Device Manufactured04/07/2023
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 Number1
Outcome Attributed to Adverse Event Other;
Patient SexUnknown
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